Hemocultivos positivos: un estudio de seis años en un hospital de tercer nivel con énfasis en los patrones de sensibilidad antimicrobiana
Resumen
La bacteriemia se presenta en forma frecuente en los pacientes hospitalizados 1 y se ha convertido en una importante fuente de infección nosocomial
representando en este caso, una fuente trascendente de morbi-mortalidad23 Los pacientes con infecciones del torrente sanguíneo tienen un riesgo tres veces
mayor de morir que los pacientes con una enfermedad subyacente pero sin microorganismos en sangre4. Se ha estimado que hay 500.000 casos de bacteriemia cada año con una mortalidad que puede alcanzar el 35%.5 La rápida y correcta detección junto con la posterior identificación de los microorganismos presentes en la sangre permanecen críticos para que un apropiado esquema terapéutico pueda ser iniciado.6
Hay una marcada variación geográfica en la frecuencia de bacteriemia, también como en el organismo responsable y los patrones de susceptibilidad. La combinación de ampicilina y gentamicina es considerada ser la mas apropiada para el tratamiento de bacteriemia en los países en vías de desarrollo. Sin embargo estudios recientes han revelado que los patógenos responsables son cada vez más resistentes a estos dos antimicrobianos por lo que el uso de las cefalosporinas de tercera generación se ha incrementado notablemente, al igual que el uso de otras alternativas de tratamiento como son fluoroquinolonas y carbapenemes.
El propósito de este estudio fue(1) describir la epidemiología de las bacteriemias en los pacientes que acuden al Hospital Vozandes en Quito en un período
de 6 años (1996-20001) y(2) describir los patrones de susceptibilidad de los agentes causantes de bacteriemias
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2.- Make, D.G. 1981. Nosocomial bacteremia: an epidemiologic overview. Am. J. Med. 70:719-732
3.- Wenzel, R.R, M.R. Pinsky, R.J. Ulevitch, and L. Young. 1996. Current understanding of sepsis. Clin. Infect. Dis. 22:407-413
4.- Wenzel, R.R 1992. Anti-endotoxin monoclonal antibodies- a second look. N. Engl. J. Med. 326:1151-1153.
5.- Woese, C.R. 1987. Bacterial evolution. Microbiol. Rev. 51:221-271
6.- Trenholme, C.D., R.D. Kaplan, R Karakusis, et al. 1989. Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates. J. Clin. Microbiol. 27:1342-1345
7.- Murray, RR., EJ. Barón., M.A. Pfaller, et al. 1999. Manual of Clinical Microbiology. American Society for Microbiology. 7th ed. Washington D.C:
8.- Stelling, J., T. O'Brien. 1997. Surveillance of antimicrobial resistance: the WHONET program. Clin. Infect. Dis. 24 (Suppl 1): S157-165
9.- Jorgensen, J.H., A.W: Howell and L.A. Maher. 1991. Quantitative antimicrobial susceptibility testing of Haemophilus influenzae and Streptococcus pneumoniae by using E-test. J Clin Microbiol 29:109-114
10.- National Committee for Clinical Laboratory Standars. Perfomance Standars for Antimicrobial Disk Susceptibility Test-Sixth Edition: Approved Standard. M2-A6. 1997: Vol 17. No 1.
11.- Rupp, M.E., and G.L. Archer. 1994. Coagulase-negative staphylococci: pathogens associated with medical progress.Clin. Infect. Dis. 19:231-243.
12.- Weinstein, M.P., L.B. Reller, J.R. Murphy, and K.A. Lichtenstein. 1983. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. Laboratory and epidemiologic observations. Rev. Infect. Dis. 5:35-53
13.- Weinstein, M.P., M.L. Towns, S.M. Quartey, et al. 1997. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect. Dis. 24:584-602
14.- Bates, D.W., L. Goldman, and T.H. Lee. 1991. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 265:365-369
15.- Kirchhoff, L.V. and J.N. Sheagren. 1985. Epidemiology and clinical significance of blood cultures positive for coagulase-negative staphylococcus. Infect. Control. 6:479- 486
16.- Peacock, S J., I. C. Bowler, and D.W. Crook. 1995. Positive predictive valué of blood cultures growing coagulasenegative staphylococci. Lancet. 346:191-192
17.- Siegman-Igra, Y., and C. Emst. 2000. Nosocomial bloodstream infections: are positive blood cultures misleading? Clin. Infect. Dis. 30:986
18.- Mirret S., M. P. Weinstein, L.G. Reimer, et al. 2001. Relevance of the number of positive bottles in determining clinical significance of coagulase negative Staphylococci in Blood Cultures. J. Clin. Microbiol. 39:3279-3281.
19.- Haddon., R.A. P.L. Bamett, K. Grimwood, et al. 1999. Bacteremia in febrile children presenting to a paediatric emergency department. Med J. Aust. 170:263-268
20.- Lee, G.M. M.B. Harper. 1998. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era. Arch. Pediatr. Adolesc Med. 152:624-628
21.- Pfaller, M.A., R.N. Jones, et al. 1998. National surveillance of nosocomial blood stream infections due to species of Candida other than Candida albicans: frequency of ocurrence and antifungal susceptibility in the SCOPE. Program. Diagn. Microbiol. Infect Dis. 30:121-129.
2 2 - Pfaller, M.A., S.A. Messer, RJ. Hollis, et al. 1999. Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States. Mycology. 33:217-222
23.- Espinel-Ingroff, A., C. W. Kish, Jr., T.M. Kerkering, et al. 1992. Collaborative comparison of broth macrodilution and microdilution antifungal susceptibility test. J. Clin Microbiol. 30:3138-3145
24.- Newman, S.L.,T.P. Flanigan, A. Fisher, et al. 1994. Clinical significant mucosal candidiasis resistant to fluconazole treatment in patients with AIDS. Clin Infect Dis. 19:684- 686.
25.- Chang, H.C., JJ. Chang, A.H. Huang, et al. 2000. Evaluation of a capacitance method for direct antifungal susceptibility testing yeast in positive blood cultures. J. Clin Microbiol. 38:971-976.
26. Nguyen, M.H., J.E. Peacock, Jr., A.J. Morrison, et al. 1996. The changing face of candidemia emergence of non- Candida albicans species ans antifungal resistance. Am. J.Med. 100:617-623.
2 7 - Bulger, R.J., and J.C. Sherris. 1966. Clinical significance of Aeromonas hydrophila. Arch. Intem. Med. 118:562-564.
28.- Dean, H.M., and R.M. Post. 1967. Fatal infection with Aeromonas hydrophila in a patient with acute myelogenous leukemia. Ann. Intem. Med. 66:1177-1179
29.- Von Graevenitz, A., and A.H. Mensch. 1968. The genus Aeromonas in human bacteriology: a report of 30 cases and a review of the literature. N. Engl. J. Med. 278:245-249.
30.- Ketover, B. P., L.S. Young, and D. Armstrong. 1973. Septicemia due to Aeromonas hydrophila: clinical and immunologic aspects. J. Infect. Dis. 127:284-290
31.- Davis, W.A., J.G. Kane, and V.F. Garagusi. 1978. Human Aeromonas infection. Medicine (Baltimore) 57:267-277
32.- Honburg, P.Z., and Gutschik. 1987. Streptococcus bovis bacteraemia and its association with alimentary tract neoplasms. Lancet 1:163-164 (letter).
33.- Bretzke, M.L., M. P. Burbrick, and C.R. Hitchcock. 1988. Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression. Surg. Gynecol. Obstet. 166:197-199
34 - Ramsay, A.M. 1949. The significance of Clostridium welchii in the cervical swab and bloodstream in post-partum and post-abortion sepsis. Br. J. Obstet, Gynaecol. 56:247- 258
35.- Gorbach, S.L. and H. Thadepalli. 1975. Isolation of Clostridium in human infection: evaluation of 114 cases. J. Infect. Dis. 131:S81-S85
36.- Yuen, K.Y., W.H. Seto, C.H. Choi, et al. 1990. Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong. J. Infect. 21:241-250
37.- Skogberg, K., H. Simonen, O.V. Renkonen et al. 1988. Beta haemolytic group A,B ,C and G streptococccal septicaemia: a clinical study. Scand. J. Infect. Dis. 20:119-125
38.- Auckenthaler, R.P. E. Hermans, and J.A. Washington II. 1983. Group G streptococcal bacteremia: clinical study and review of the literature. Rev. Infect. Dis. 5:196-204
2.- Make, D.G. 1981. Nosocomial bacteremia: an epidemiologic overview. Am. J. Med. 70:719-732
3.- Wenzel, R.R, M.R. Pinsky, R.J. Ulevitch, and L. Young. 1996. Current understanding of sepsis. Clin. Infect. Dis. 22:407-413
4.- Wenzel, R.R 1992. Anti-endotoxin monoclonal antibodies- a second look. N. Engl. J. Med. 326:1151-1153.
5.- Woese, C.R. 1987. Bacterial evolution. Microbiol. Rev. 51:221-271
6.- Trenholme, C.D., R.D. Kaplan, R Karakusis, et al. 1989. Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates. J. Clin. Microbiol. 27:1342-1345
7.- Murray, RR., EJ. Barón., M.A. Pfaller, et al. 1999. Manual of Clinical Microbiology. American Society for Microbiology. 7th ed. Washington D.C:
8.- Stelling, J., T. O'Brien. 1997. Surveillance of antimicrobial resistance: the WHONET program. Clin. Infect. Dis. 24 (Suppl 1): S157-165
9.- Jorgensen, J.H., A.W: Howell and L.A. Maher. 1991. Quantitative antimicrobial susceptibility testing of Haemophilus influenzae and Streptococcus pneumoniae by using E-test. J Clin Microbiol 29:109-114
10.- National Committee for Clinical Laboratory Standars. Perfomance Standars for Antimicrobial Disk Susceptibility Test-Sixth Edition: Approved Standard. M2-A6. 1997: Vol 17. No 1.
11.- Rupp, M.E., and G.L. Archer. 1994. Coagulase-negative staphylococci: pathogens associated with medical progress.Clin. Infect. Dis. 19:231-243.
12.- Weinstein, M.P., L.B. Reller, J.R. Murphy, and K.A. Lichtenstein. 1983. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. Laboratory and epidemiologic observations. Rev. Infect. Dis. 5:35-53
13.- Weinstein, M.P., M.L. Towns, S.M. Quartey, et al. 1997. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect. Dis. 24:584-602
14.- Bates, D.W., L. Goldman, and T.H. Lee. 1991. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 265:365-369
15.- Kirchhoff, L.V. and J.N. Sheagren. 1985. Epidemiology and clinical significance of blood cultures positive for coagulase-negative staphylococcus. Infect. Control. 6:479- 486
16.- Peacock, S J., I. C. Bowler, and D.W. Crook. 1995. Positive predictive valué of blood cultures growing coagulasenegative staphylococci. Lancet. 346:191-192
17.- Siegman-Igra, Y., and C. Emst. 2000. Nosocomial bloodstream infections: are positive blood cultures misleading? Clin. Infect. Dis. 30:986
18.- Mirret S., M. P. Weinstein, L.G. Reimer, et al. 2001. Relevance of the number of positive bottles in determining clinical significance of coagulase negative Staphylococci in Blood Cultures. J. Clin. Microbiol. 39:3279-3281.
19.- Haddon., R.A. P.L. Bamett, K. Grimwood, et al. 1999. Bacteremia in febrile children presenting to a paediatric emergency department. Med J. Aust. 170:263-268
20.- Lee, G.M. M.B. Harper. 1998. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era. Arch. Pediatr. Adolesc Med. 152:624-628
21.- Pfaller, M.A., R.N. Jones, et al. 1998. National surveillance of nosocomial blood stream infections due to species of Candida other than Candida albicans: frequency of ocurrence and antifungal susceptibility in the SCOPE. Program. Diagn. Microbiol. Infect Dis. 30:121-129.
2 2 - Pfaller, M.A., S.A. Messer, RJ. Hollis, et al. 1999. Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States. Mycology. 33:217-222
23.- Espinel-Ingroff, A., C. W. Kish, Jr., T.M. Kerkering, et al. 1992. Collaborative comparison of broth macrodilution and microdilution antifungal susceptibility test. J. Clin Microbiol. 30:3138-3145
24.- Newman, S.L.,T.P. Flanigan, A. Fisher, et al. 1994. Clinical significant mucosal candidiasis resistant to fluconazole treatment in patients with AIDS. Clin Infect Dis. 19:684- 686.
25.- Chang, H.C., JJ. Chang, A.H. Huang, et al. 2000. Evaluation of a capacitance method for direct antifungal susceptibility testing yeast in positive blood cultures. J. Clin Microbiol. 38:971-976.
26. Nguyen, M.H., J.E. Peacock, Jr., A.J. Morrison, et al. 1996. The changing face of candidemia emergence of non- Candida albicans species ans antifungal resistance. Am. J.Med. 100:617-623.
2 7 - Bulger, R.J., and J.C. Sherris. 1966. Clinical significance of Aeromonas hydrophila. Arch. Intem. Med. 118:562-564.
28.- Dean, H.M., and R.M. Post. 1967. Fatal infection with Aeromonas hydrophila in a patient with acute myelogenous leukemia. Ann. Intem. Med. 66:1177-1179
29.- Von Graevenitz, A., and A.H. Mensch. 1968. The genus Aeromonas in human bacteriology: a report of 30 cases and a review of the literature. N. Engl. J. Med. 278:245-249.
30.- Ketover, B. P., L.S. Young, and D. Armstrong. 1973. Septicemia due to Aeromonas hydrophila: clinical and immunologic aspects. J. Infect. Dis. 127:284-290
31.- Davis, W.A., J.G. Kane, and V.F. Garagusi. 1978. Human Aeromonas infection. Medicine (Baltimore) 57:267-277
32.- Honburg, P.Z., and Gutschik. 1987. Streptococcus bovis bacteraemia and its association with alimentary tract neoplasms. Lancet 1:163-164 (letter).
33.- Bretzke, M.L., M. P. Burbrick, and C.R. Hitchcock. 1988. Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression. Surg. Gynecol. Obstet. 166:197-199
34 - Ramsay, A.M. 1949. The significance of Clostridium welchii in the cervical swab and bloodstream in post-partum and post-abortion sepsis. Br. J. Obstet, Gynaecol. 56:247- 258
35.- Gorbach, S.L. and H. Thadepalli. 1975. Isolation of Clostridium in human infection: evaluation of 114 cases. J. Infect. Dis. 131:S81-S85
36.- Yuen, K.Y., W.H. Seto, C.H. Choi, et al. 1990. Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong. J. Infect. 21:241-250
37.- Skogberg, K., H. Simonen, O.V. Renkonen et al. 1988. Beta haemolytic group A,B ,C and G streptococccal septicaemia: a clinical study. Scand. J. Infect. Dis. 20:119-125
38.- Auckenthaler, R.P. E. Hermans, and J.A. Washington II. 1983. Group G streptococcal bacteremia: clinical study and review of the literature. Rev. Infect. Dis. 5:196-204
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Publicado
2017-06-09
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1.
Zurita J, Noriega V, Vargas AC, Ordóñez M, Izurieta Y. Hemocultivos positivos: un estudio de seis años en un hospital de tercer nivel con énfasis en los patrones de sensibilidad antimicrobiana. Rev Fac Cien Med (Quito) [Internet]. 9 de junio de 2017 [citado 4 de mayo de 2024];28(1-3):32-4. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/976
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