Resistencia antimicrobiana de escherichia coli en infecciones de vias urinarias, protocolo de patrón de sensibilidad
Fecha
2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Una de las causas más frecuente de consulta de atención primaria son las infecciones de vías urinarias teniendo como patógeno más frecuente la Escherichia coli. En años recientes, la administración indiscriminada de antimicrobianos ha resultado en la selección de cepas resistentes que producen fracaso del tratamiento empírico y complicación de los procesos infecciosos, por ello este estudio de caso cualitativo instrumental propone como objetivo establecer un protocolo de patrón de sensibilidad de Escherichia coli en infección de vías urinarias para ser empleado en el Centro de Investigación Microbiológica de la ciudad de Guayaquil, analizando urocultivos recibidos en el periodo octubre-noviembre 2015 en el Centro de Investigación Microbiológica, analizando los patrones de resistencia de E. coli para demostrar la sensibilidad a los antimicrobianos. Fueron analizadas los datos de los reportes de urocultivos que tuvieron crecimiento bacteriano. La resistencia se evaluó bajo parámetros de Clinical and Laboratory Standards Institute (CLSI 2015), mediante método manual de difusión de disco Kirby-Bauer con sensidiscos. Obteniendo como resultado, dentro de las categorías de factores microbiológicos, de ellos 67,74% con el germen E. coli identificado mediant el equipo automatizado Maldi Tof, a los cuales se les realizaron antibiogramas con el empleo de discos de antibióticos: amikacina, ciprofloxacina, fosfomicina, amoxicilina/ácido-clavulanico, trimetropinsulfametoxazol, cefotaxima, ceftazidima, nitrofurantoina, imipenem. En relación a los factores biológicos el sexo más afectado fue el femenino. De acuerdo a los factores terapéuticos E. coli mostró sensibilidad alta para imipenem (100%), fosfomicina (80,95 %), amikacina (80,95 %), mientras que la mayor resistencia la presenta frente a trimetropin-sulfametoxazol(75,23%), amoxi/ ac. clavulanico (68.57 %), ciprofloxacina (45.71%), cefotaxima (38.09%), nitrofurantoina (37.14%) y ceftazidima (33.33%). Se concluye que la mejor opción terapéutica puede ser el uso en primera línea de fosfomicina, amikacina para el manejo de infecciones de vías urinarias y eliminar del tratamiento empírico trimetropin/sulfametoxazol por la alta resistencia encontrada.
One of the most common causes of primary care consultation are urinary tract infections having as most frequent pathogen Escherichia coli. In recent years, the indiscriminate use of antimicrobials has resulted in the selection of resistant strains that produce failure of empirical treatment and complication of infectious processes, so an objective was proposed to establish a protocol of sensitivity pattern of Escherichia coli infection of urinary tract to be used in the Microbiological Research Center of the city of Guayaquil. Studying urine cultures received during the period October-November 2015, analyzing patterns Escherichia coli resistance to demonstrate the antimicrobial susceptibility. There were analyzed urine cultures from both men and women. The resistance was evaluated under the parameters of the Clinical and Laboratory Standards Institute (CLSI 2015), by manual disk diffusion method of Kirby-Bauer with sensi-discs. Resulting in positive cultures, of which 67,74% was Escherichia coli germ identified by automated equipment Maldi Tof, to which were performed antibiograms with the use of antibiotic disks, amikacin, ciprofloxacin, fosfomycin, amoxicillin / clavulanate , trimethoprim-sulfamethoxazole, cefotaxime, ceftazidime, nitrofurantoin, imipenem. The most affected was the female gender. Escherichia coli showed high sensitivity to imipenem (100%), fosfomycin (80.9%), amikacin (80.9%), while the higher resistance against trimethoprim-sulfamethoxazole (75.23%), amoxicillin / clavulanate (68.57 %), ciprofloxacin (45.71%), ceftazidime (38.09%), nitrofurantoin (37.14%) and cefotaxime (33.33%). The best treatment option may be the first-line use of fosfomycin, amikacin for the treatment of urinary tract infections and eliminate the trimethoprim / sulfamethoxazole empirical treatment for high resistance encountered.
One of the most common causes of primary care consultation are urinary tract infections having as most frequent pathogen Escherichia coli. In recent years, the indiscriminate use of antimicrobials has resulted in the selection of resistant strains that produce failure of empirical treatment and complication of infectious processes, so an objective was proposed to establish a protocol of sensitivity pattern of Escherichia coli infection of urinary tract to be used in the Microbiological Research Center of the city of Guayaquil. Studying urine cultures received during the period October-November 2015, analyzing patterns Escherichia coli resistance to demonstrate the antimicrobial susceptibility. There were analyzed urine cultures from both men and women. The resistance was evaluated under the parameters of the Clinical and Laboratory Standards Institute (CLSI 2015), by manual disk diffusion method of Kirby-Bauer with sensi-discs. Resulting in positive cultures, of which 67,74% was Escherichia coli germ identified by automated equipment Maldi Tof, to which were performed antibiograms with the use of antibiotic disks, amikacin, ciprofloxacin, fosfomycin, amoxicillin / clavulanate , trimethoprim-sulfamethoxazole, cefotaxime, ceftazidime, nitrofurantoin, imipenem. The most affected was the female gender. Escherichia coli showed high sensitivity to imipenem (100%), fosfomycin (80.9%), amikacin (80.9%), while the higher resistance against trimethoprim-sulfamethoxazole (75.23%), amoxicillin / clavulanate (68.57 %), ciprofloxacin (45.71%), ceftazidime (38.09%), nitrofurantoin (37.14%) and cefotaxime (33.33%). The best treatment option may be the first-line use of fosfomycin, amikacin for the treatment of urinary tract infections and eliminate the trimethoprim / sulfamethoxazole empirical treatment for high resistance encountered.
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Resistencia antimicrobiana, Infecciones urinarias, Escherichia coli, Preotocolos, Centro de Investigación Microbiológica, Cantón Guayaquil, Ecuador