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      Diarreas asociadas a Shigella con un patrón de resistencia antimicrobiana alto en el cantón de Coto Brus, Costa Rica

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          Abstract

          Se analizaron 420 muestras diarreicas de pacientes admitidos en el Hospital San Vito, Puntarenas; Costa Rica durante enero del 2001 a enero del 2002 y se determinó el porcentaje de resistencia de Shigella sp a 8 antibióticos de primera línea. El 65,1% de las cepas se aislaron durante los meses de octubre a diciembre de12001. Se aislaron 142 cepas de Shigella flexneri y 6 de Shigella sonnei. El 70% mostraron resistencia a TrimetoprinSulfametoxazole, tetraciclina y ampicilina, siendo todas las cepas sensibles a la gentamicina, cefotaxima y ciprofloxacina. El estudio mostró que la mayoría de las cepas aisladas presentaron una alta resistencia a los antibióticos comúnmente utilizados en el tratamiento de las enfermedades diarreicas. Por lo tanto, se recomienda un monitoreo continuo de los patrones de resistencia para un subsecuente tratamiento.

          Translated abstract

          Among 420 diarrheic simples from patients from the San Vito Hospital, Puntarenas, Costa Rica, were essayed from 2001, January to 2002, January. The percentage of resistance of Shigella sp; to eight of the first line antibiotics, was determined. The 65.1 % of the strains were isolated between October and December of 2001. One hundred and forty two of the strains isolated were Shigella flexneri and six were Shigella sonnei. The 70% of the strains shown resistance to Trimethoprim / Sulfametoxazole, tetracycline and ampicillin. AII of the strains were susceptibles to gentamicin, cefotaxime and ciprofloxacin. The case studies determined that most of the strains isolated, have an higher resistant rate to the most used antibiotics in treatment against diarrheic illness. For hence, it is important the continual monitoring of the resistance patterns for a subsequentt reatment.

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          Most cited references28

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          Antimicrobial-resistant bacterial diarrhea in rural western Kenya.

          Bacterial diarrheal diseases cause substantial morbidity and mortality in sub-Saharan Africa, but data on the epidemiology and antimicrobial susceptibility patterns of enteric bacterial pathogens are limited. Between May 1997 and April 1998, a clinic-based surveillance for diarrheal disease was conducted in Asembo, a rural area in western Kenya. In total, 729 diarrheal specimens were collected, and 244 (33%) yielded >or=1 bacterial pathogen, as determined by standard culture techniques; 107 (44%) Shigella isolates, 73 (30%) Campylobacter isolates, 45 (18%) Vibrio cholerae O1 isolates, and 33 (14%) Salmonella isolates were identified. Shigella dysenteriae type 1 accounted for 22 (21%) of the Shigella isolates. Among 112 patients empirically treated with an antimicrobial agent and whose stool specimens yielded isolates on which resistance testing was done, 57 (51%) had isolates that were not susceptible to their antimicrobial treatment. Empiric treatment strategies for diarrheal disease in western Kenya need to be reevaluated, to improve clinical care.
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            Emergence of antimicrobial-resistant shigellosis in Oregon.

            Ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) are currently considered acceptable empirical therapy for shigellosis in developed countries. However, there are few recently reported studies on antimicrobial resistance among shigellae isolated in the United States. We examined the epidemiology of shigellosis and the antimicrobial susceptibility of Shigella species isolated in Oregon from July 1995 through June 1998. Of 430 isolates, 410 were identified to the species level: Shigella sonnei accounted for 55% of isolates, and Shigella flexneri, for 40%. The overall annual incidence of shigellosis was 4.4 cases per 100,000 population. Children aged <5 years (annual incidence, 19.6 cases per 100,000 population) and Hispanics (annual incidence, 28.4 cases per 100,000 population) were at highest risk. Of 369 isolates tested, 59% were resistant to TMP-SMZ, 63% were resistant to ampicillin, 1% were resistant to cefixime, and 0.3% were resistant to nalidixic acid; none of the isolates were resistant to ciprofloxacin. Thirteen percent of the isolates had multidrug resistance to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline. Infections due to multidrug-resistant shigellae are endemic in Oregon. Neither ampicillin nor TMP-SMZ should be considered appropriate empirical therapy for shigellosis any longer; when antibiotics are indicated, a quinolone or cefixime should be used.
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              The role of antibiotics in the treatment of infectious diarrhea.

              Infectious diarrhea is a significant cause of morbidity and mortality and a common complaint in clinical practice. Routine empirical use of antibiotics for infectious diarrhea should be avoided because of the self-limited nature of most cases, the cost of antibiotics, and the potential to worsen the already significant problem of antibiotic resistance of enteric pathogens. For patients with severe invasive or prolonged diarrhea or who are at high risk of complications, such as the elderly, diabetics, cirrhotics, and immunocompromised patients, empirical treatment with a quinolone antibiotic for 3 to 5 days can be considered. Antibiotic treatment can be highly effective for Shigella, ETEC, and V. cholerae infections, and metronidazole is indicated for C. difficile colitis. The impact of antibiotics for other specific pathogens is modest, and antibiotic therapy should be reserved for the same group of patients who would be considered for empirical treatment. The most significant problem in the antibiotic treatment of infectious diarrhea is the progressive increase in resistance among enteric pathogens; only the prudent use of antimicrobials in all areas of daily practice can limit or delay the impact of this serious problem.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rccm
                Revista Costarricense de Ciencias Médicas
                Rev. costarric. cienc. méd
                Editorial Nacional de Salud y Seguridad Social (San José )
                0253-2948
                January 2003
                : 24
                : 1-2
                : 55-60
                Affiliations
                [1 ] Caja Costarricense de Seguro Social Costa Rica
                Article
                S0253-29482003000100006
                961dd7e3-e3f6-433e-bed4-c96b8566f595

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=0253-2948&lng=en

                Shigella,diarrheic,resistance,diarrea,resistencia
                Shigella, diarrheic, resistance, diarrea, resistencia

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