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      Susceptibilidad antimicrobiana de cepas de Pseudomonas aeruginosa aisladas en el laboratoriodel Hospital Regional Dr. Leonardo Guzmán de Antofagasta, Chile Translated title: In vitro antimicrobial susceptibility of Pseudomonas aeruginosa strains isolated at Hospital Dr. Leonardo Guzmán, Antofagasta, Chile

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          Abstract

          Pseudomonas aeruginosa es un patógeno nosocomial frecuente que presenta elevada resistencia a los antimicrobianos y causa infecciones graves cuando hay alteración de los mecanismos defensivos del paciente. Así, conocer los patrones locales de sensibilidad es importante para la elección del tratamiento antimicrobiano adecuado en cada institución. En este trabajo determinamos la susceptibilidad antimicrobiana de cepas de P. aeruginosa aisladas desde pacientes atendidos en el Hospital Regional de Antofagasta. La mayoría de los pacientes tenía alguna condición predisponente a la infección y 48% tenía una infección grave. Las cepas mostraron mayor resistencia a los antimicrobianos que lo reportado en trabajos nacionales previos. Las cepas fueron altamente resistentes a amikacina (36,8%), ceftazidima (36,8%) y ciprofloxacina (68,4%), moderadamente resistentes a imipenem (26,3%), mientras que eran escasamente resistentes a piperacilina/tazobactam (5,3%) y cefoperazona/sulbactam (15,8%), Este es el primer trabajo, realizado en nuestra región, que estudia la susceptibilidad de P. aeruginosa frente a distintos grupos de antimicrobianos utilizados en clínica

          Translated abstract

          Pseudomonas aeruginosa is a nosocomial pathogen that often displays a high degree of antibiotic resistance. This pathogen causes also serious infections specially in patients with severe diseases or immunodeficiency. To offer the best treatment in every institution it is necessary to know the local pattern of antimicrobial susceptibility, then we studied the antibiotic susceptibility of P. aeruginosa strains isolated from patients attended in the Regional Hospital of Antofagasta. Most of them had an underlying disease that predisposed them to the infection and 48% had a severe infection. The strains showed higher drug resistance than that reported by other chilean researchers. P. aeruginosa displayed high resistance to amikacin (36,8%), ceftazidime (36,8%) and ciprofloxacin (68,4%) intermediate resistance to imipenem (26,3%), but low resistance to piperacillin/tazobactam (5,3%) and cefoperazone/sulbactam (15,8%). This is the first drug susceptibility study conducted in the Second Region of Chile, where P. aeruginosa was assayed against those antibiotics used in the clinical practice

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          Most cited references43

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          Cell-to-cell signaling and Pseudomonas aeruginosa infections.

          Pseudomonas aeruginosa is a bacterium responsible for severe nosocomial infections, life-threatening infections in immunocompromised persons, and chronic infections in cystic fibrosis patients. The bacterium's virulence depends on a large number of cell-associated and extracellular factors. Cell-to-cell signaling systems control the expression and allow a coordinated, cell-density-dependent production of many extracellular virulence factors. We discuss the possible role of cell-to-cell signaling in the pathogenesis of P. aeruginosa infections and present a rationale for targeting cell-to-cell signaling systems in the development of new therapeutic approaches.
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            Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa.

            Antimicrobial resistance is an increasing problem. To examine the clinical and economic impact of antibiotic resistance in Pseudomonas aeruginosa. In-hospital mortality, secondary bacteremia, length of stay, and hospital charges were examined in a cohort of 489 inpatients with positive clinical cultures for P aeruginosa. One hundred forty-four had a resistant baseline P aeruginosa isolate and 30 had resistance emerge during follow-up. Multivariable and survival analytic methods were used to adjust for confounding and effects of time. The overall in-hospital mortality rate was 7.6%, 7.7% in patients with a resistant isolate at baseline (relative risk [RR], 1.3; 95% confidence interval [CI], 0.6-2.8) and 27% in patients in whom resistance emerged (RR, 3.0; 95% CI, 1.2-7.8). Secondary bacteremia developed in 1.4% of patients in whom resistance did not emerge and in 14% of those in whom resistance emerged (RR, 9.0; 95% CI, 2.7-30). The median duration of hospital stay following the initial P aeruginosa isolate was 7 days. Emergence of resistance, but not baseline resistance, was significantly associated with a longer hospital stay (P<.001 and P=.71, respectively). The average daily hospital charge was $2059. Neither baseline resistance nor emergence of resistance had a significant effect on the daily hospital charge. In a matched cohort analysis, a trend was seen toward increased total charges in patients demonstrating emergence of resistance (difference, $7340; P=.14). Emergence of antibiotic resistance in P aeruginosa results in severe adverse outcomes. Efforts should be directed toward early detection and prevention of emergence of antibiotic resistance.
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              Comparison of imipenem and ceftazidime as therapy for severe melioidosis.

              An open, prospective, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of high-dose intravenous imipenem and ceftazidime for acute severe melioidosis. Adult Thai patients with suspected acute, severe melioidosis were randomized to receive either imipenem, at a dosage of 50 mg/(kg x d), or ceftazidime, at a dosage of 120 mg/(kg x d), for a minimum of 10 days. The main outcome measures were death or treatment failure. Of the 296 patients enrolled, 214 had culture-confirmed melioidosis, and 132 (61.7%) of them had positive blood cultures. Mortality among patients with melioidosis was 36.9% overall. There were no differences in survival overall (P = .96) or after 48 hours (P = .3). Treatment failure after 48 hours was more common among patients treated with ceftazidime (P = .011). Both treatments were well tolerated. Imipenem is a safe and effective treatment for acute severe melioidosis and may be considered an alternative to ceftazidime.
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                Author and article information

                Journal
                rci
                Revista chilena de infectología
                Rev. chil. infectol.
                Sociedad Chilena de Infectología (Santiago, , Chile )
                0716-1018
                June 2004
                : 21
                : 2
                : 117-124
                Affiliations
                [02] orgnameUniversidad de Antofagasta orgdiv1Facultad de Ciencias de la Salud orgdiv2Unidad de Microbiología Chile
                [01] Antofagasta orgnameHospital Dr. Leonardo Guzmán orgdiv1Unidad de Cuidados Intensivos Chile
                Article
                S0716-10182004000200003 S0716-1018(04)02100203
                10.4067/S0716-10182004000200003
                4cb80adb-85fa-4b6e-88d9-e7515044fc08

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 06 March 2004
                : 15 October 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 43, Pages: 8
                Product

                SciELO Chile

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                MICROBIOLOGÍA CLÍNICA

                Pseudomonas aeruginosa,minoglucósidos,Carbapenems,Susceptibilidad antimicrobiana,Aminoglycosides,Drug susceptibility

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