IntroductionInfections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy.MethodsBetween July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction.Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information.ResultsA total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7–9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1–13.7; p < 0.001) were independently associated with in-hospital mortality.ConclusionsThis study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.

During 2005, 66 carbapenem-resistant isolates of Acinetobacter baumannii were collected from seven tertiarycare hospitals participating in a nationwide surveillance network in Colombia. The isolates were multidrug resistant and produced the carbapenemases OXA-23 and OXA-51. Forty-five belonged to four clones while 21 were unique pulsotypes. One clone was present in two hospitals within one city, while another had spread between two hospitals in different cities. Blood, secretions, and abdominal fluids were the most frequent sites of isolation. This is the first description of widespread dissemination of OXA-23 in South America.Acinetobacter baumannii is an important nosocomial pathogen which appears to be increasing in frequency (8). Carbapenems have been the drugs of choice for treatment of severe Acinetobacter infections, but their efficacy is increasingly compromised by resistance (19).According to the SENTRY reports, resistance rates for nosocomial gram-negative pathogens, including A. baumannii, are higher in Latin American countries than in the United States or Europe. The prevalence of carbapenem resistance in A. baumannii isolates across Latin America in the SENTRY database in 2001 was estimated at 25% (13,24). During 2005, carbapenem resistance rates for A. baumannii were around 40% in 12 Colombian tertiary-care hospitals (18).Carbapenem-hydrolyzing OXA enzymes are the most important cause of carbapenem resistance in A. baumannii worldwide (23). These began to be described over a decade ago, in 1993, with the description of ARI-1, later renamed OXA-23, in an imipenem-resistant A. baumannii strain from a patient in the Edinburgh Royal Infirmary (22). The strain was isolated in 1985, before the use of imipenem in the hospital. Imipenem resistance was subsequently demonstrated to be transferable (25). Since then, carbapenem-resistant isolates of A. baumannii carrying oxacillinases have been reported worldwide (4,14,29). It has been recognized that most A. baumannii strains have a chromosomal carbapenemase gene (a bla OXA-51 -like gene) (10), though this is expressed at a high level only if an insertion sequence, such as ISAba1, is inserted upstream (30). In addition, a minority of A. baumannii strains have further OXA carbapenemase genes that are not part of the normal genomic repertoire of the species; these include the bla OXA-23 -like gene, the bla OXA-24 -like gene, and bla . Although they are lessefficient hydrolyzers of carbapenems in vitro than are the metallo-␤-lactamases (M␤Ls), these oxacillinases can inactivate carbapenems and their presence or activation by ISAba1 is demonstrably correlated with resistance (4, 30).Based on the high rates of resistance to carbapenems in A. baumannii strains from 10 tertiary-care hospitals in the Colombian network, an investigation into the underlying mechanisms and strain structure was undertaken.(This report was presented in part at the 46th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, 2006 [13a].) MATERIALS AND M...

The combination of 2 evolutionary mechanisms of KPC-Kpn within a challenged health system of a developing country created the "perfect storm" for sustained endemicity of these multidrug-resistant organisms in Colombia.

fThe ability of Pseudomonas aeruginosa to develop resistance to most antimicrobials represents an important clinical threat worldwide. We report the dissemination in several Colombian hospitals of two predominant lineages of extensively drug-resistant (XDR) carbapenemase-producing P. aeruginosa strains. These lineages belong to the high-risk clones sequence type 111 (ST111) and ST235 and harbor bla VIM-2 on a class 1 integron and bla KPC-2 on a Tn4401 transposon, respectively. Additionally, P. aeruginosa ST1492, a novel single-locus variant of ST111, was identified. Clonal dissemination and the presence of mobile genetic elements likely explain the successful spread of XDR P. aeruginosa strains in Colombia.

Polymyxins are last-resort antimicrobial agents used to treat infections caused by carbapenem-resistant Due to the worldwide dissemination of polymyxin resistance in animal and human isolates, we aimed to characterize polymyxin resistance associated with the presence of in and nonfermenter Gram-negative bacilli, using isolates collected retrospectively in Colombia from 2002 to 2016. A total of 5,887 Gram-negative clinical isolates were studied, and 513 were found to be resistant to the polymyxins. Susceptibility to colistin was confirmed by broth microdilution for all-positive isolates, and these were further subjected to whole-genome sequencing (WGS). The localization of was confirmed by S1 pulsed-field gel electrophoresis (S1-PFGE) and CeuI-PFGE hybridization. Transferability was evaluated by mating assays. A total of 12 colistin-resistant isolates recovered after 2013 harbored, including 8 , 3 serovar Typhimurium, and 1 isolate isolates were unrelated by PFGE and belonged to 7 different sequence types (STs) and phylogroups. Typhimurium and isolates belonged to ST34 and ST307, respectively. The gene was plasmid borne in all isolates but two isolates which harbored it on the chromosome. Conjugation of was successful in 8 of 10 isolates (8.2 × 10 to 2.07 × 10 cell per recipient). Plasmid sequences showed that the plasmids belonged to four different Inc groups (a new IncP-1 variant and the IncFII, IncHI1, and IncH families). Our results indicate that is circulating in clinical isolates of colistin-resistant in Colombia and is mainly harbored in transferable plasmids.

No abstract

RESUMEN Introducción Las infecciones del tracto urinario (ITU) son frecuentes en la comunidad. Sin embargo, la información de aislamientos resistentes en este contexto es limitada en Latinoamérica. Este estudio tiene como objetivo determinar la prevalencia y los factores de riesgo asociados con ITU de inicio en la comunidad (ITU-IC) causadas por Escherichia coli productor de betalactamasas de espectro extendido (BLEE) en Colombia. Materiales y métodos Entre agosto y diciembre de 2011 se realizó un estudio de casos y controles en 3 instituciones de salud de tercer nivel en Colombia. Se invitó a participar a todos los pacientes admitidos a urgencias con diagnóstico probable de ITU-IC, y se les pidió una muestra de orina. En los aislamien-tos de E. coli se realizaron pruebas confirmatorias para BLEE, susceptibilidad antibiótica, caracterización molecular (PCR en tiempo real para genes bla, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] y factores de virulencia por PCR). Se obtuvo información clínica y epidemiológica, y posteriormente se realizó el análisis estadístico. Resultados De los 2.124 pacientes seleccionados, 629 tuvieron un urocultivo positivo, en 431 de estos se aisló E. coli, 54 fueron positivos para BLEE y 29 correspondieron a CTX-M-15. La mayoría de los aislamientos de E. coli productor de BLEE fueron sensibles a ertapenem, fosfomicina y amikacina. La ITU complicada se asoció fuertemente con infecciones por E. coli productor de BLEE (OR = 3,89; IC 95%: 1,10–13,89; p = 0,03). E. coli productor de CTX-M-15 mostró 10 electroferotipos diferentes; de estos, el 65% correspondieron al ST131. La mayoría de estos aislamientos tuvieron 8 de los 9 factores de virulencia analizados. Discusión E. coli portador del gen blaCTX-M-15 asociado al ST131 sigue siendo frecuente en Colombia. La presencia de ITU-IC complicada aumenta el riesgo de tener E. coli productor de BLEE, lo cual debe tenerse en cuenta para ofrecer una terapia empírica adecuada.

No abstract