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Tem and CTX-M extended-spectrum beta-lactamase in Klebsiella spp and Escherichia coli isolates from inanimate surfaces of hospital environments. Cajamarca, Peru. Lambayeque, Peru. The aim of the study was to determine the genotype of 15 ESBL strains of Enterobacteriaceae resistant to beta-lactams, isolated from inanimate surfaces and phenotypically characterized as producing extended-spectrum beta-lactamase.
Eleven strains presented both fragments at the time and only three had blaCTX-M. In conclusion, the presence of ESBL genes in cultures from the environment was demonstrated, some of which may belong to more than one type. This information could serve as a basis for implementing preventive measures to prevent the transmission of multiresistant bacteria from inanimate surfaces to patients, mainly in critical hospital areas. CTX-Ms, which have a different evolutionary history, have intrinsic ESBL activity derived from its chromosomal predecessor in Kluyvera 2 and are the most widely reported ESBLs worldwide, predominantly in pathogens of nosocomial infections NI such as Escherichia coli and Klebsiella spp.
Although the endogenous source is the most important one, the hospital environment is a possible reservoir of these pathogens 5,6 because inanimate surfaces can be colonized by ESBL-producing bacteria 7,8 and serve as a potential source of cross-contamination and colonization of the hands of healthcare workers. The objective of this work was to determine the ESBL genotype of 15 strains of Enterobacteriaceae that were isolated from inanimate surfaces, phenotypically characterized as ESBL producers in a preliminary study at the Regional Hospital of Cajamarca 7 in north Peru.
The samples were collected by swabbing sinks, tables, beds, and other surfaces in operating rooms, the pediatric ward, medicine ward, neonatology ward, maternity ward, and intensive care units ICUs , from September to June Of 20 strains of E. Electrophoresis was performed at V for 45—60 minutes in a 1. The size of the amplified DNA was verified using a molecular-weight marker of bp.
Strains 7 E. Seven strains of K. Various studies showed that K. These data are in agreement with the present report Table 1 because of Klebsiella spp. The high contagiousness of the ESBL-producing bacteria has also been demonstrated in these studies and explains the virtuous circle and vicious circle whereby inanimate surfaces are contaminated by infected patients or by colonized healthcare personnel, who in turn become contaminated via these same surfaces 6.
This problem is exacerbated when these microorganisms express genes of resistance to multiple antimicrobials, turning the hospital environment into a reservoir for multidrug-resistant bacteria difficult to eradicate, despite the most thorough cleaning procedures used by hospitals 6.
The greater frequency of the first coincides with a greater frequency of reporting worldwide 2,3. This coincidence is important due to the wide diversity and fast dissemination corresponding to this ESBL during the NI. Some authors stated that it is common among CTX-M-producing bacteria to have different resistance phenotypes 2.
In the present study, 13 of 14 strains showed pronounced activity of cefotaximase in the screening test and only one K. The resistance phenotype where cultures show both ESBL types is an increasingly common and dangerous bacterial coproduction strategy among Klebsiella and E. In the case of culture 7, which did not have any of the genes used for testing but showed an ESBL-producing phenotype during the screening, its genotype may belong to the VHS group or an inducible chromosomal gene called Amp C, which is difficult to detect in some cases.
This is an important limitation of this study. In addition to the presence of the ESBL-positive bacterial reservoir, the difficulties with its control and treatment are also important problems because of the ease with which these and other resistance genes are disseminated among Enterobacteriaceae 1,4.
Although in the present study, no tests were performed to determine the pattern of clonality of the samples, it is important to mention that genetic relations among the selected strains could have been identified by such methods as pulsed field electrophoresis. This approach should help to determine how many clones circulate in hospitals or point to possible transmission foci.
We would like to draw the attention of healthcare authorities to our results, in order to emphasize the monitoring of transmission of these bacteria and other nosocomial pathogens from the environment, especially from potentially contaminated inanimate surfaces in critical hospital areas. In this regard, it would also be useful to establish programs for detection of ESBL and other resistance mechanisms both at the hospital level and in other scenarios, which is seldom done in Peru.
Author contributions: MRJ and CRU participated in the conception of the study, collection of data, analysis and interpretation of data, writing, critical review, and approval of the final version of the manuscript. RFC, LSL, and ZAG participated in the collection of data, analysis and interpretation of data, critical review of the manuscript, in addition to approval of the final version of the manuscript.
Conflicts of interest: The authors declare that they do not have conflicts of interest. Enferm Infecc Microbiol Clin ;32 Supl 1 Int J Med Microbiol ; Extended spectrum -lactamase producers among nosocomial Enterobacteriaceae in Latin America. Braz J Infect Dis ; 18 4 — Changing epidemiology of infections due to extended spectrum beta-lactamase producing bacteria. Antimicrob Resist Infect Control. Antimicrob Resist Infect Control ;3 1 Enferm Infecc Microbiol Clin. Rivera-Jacinto MA. Rev Esp Quimioter ;25 2 Environmental contamination with extended-spectrum b-lactamases: Is there any difference between Escherichia coli and Klebsiella spp?
Am J Infect Control ;40 9 Version 1. Mabilat C, Goussard S. Diagnostic molecular microbiology: principles and applications. Washington, D.
C: American Society for Microbiology; p. Correspondence: Marco Antonio Rivera Jacinto. Address : Av. Atahualpa — Edificio 1D. Phone number : E-mail : mrivera unc.
2019, Número 2
Cloherty JP. Maternal conditions that affect the fetus: Diabetes mellitus. In Cloherty JP, Stark. AR, editors.
Betalactamasas de espectro extendido
Leonardo Arismendy Rodriguez jlarismendy fucsalud. Gloria Restrepo B. Enviado: DOI: Clin Microbio! Antimicrob Agents Chemother. Bush K, Jacoby GA.
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Antecedentes: La gangrena de Fournier GF es una fascitis necrotizante que pone en peligro la vida del paciente. Los valores cualitativos medidos se expresaron como frecuencia y porcentaje, y se compararon con la prueba de ji al cuadrado y la prueba de Fisher. Resultados: Los pacientes que murieron presentaban con mayor frecuencia cultivos de orina y herida positivos para Escherichia coli productora de betalactamasas de espectro extendido BLEE : orina, sobrevivientes The objective of this study was to determine the etiology and impact of the agent isolated on wound and urine culture.