IntroductionGonococcal disease is one of the most common bacterial sexually transmitted infections in the world. The emergence of antimicrobial resistance of Neisseria gonorrhoeae (Ng) to the first-line antimicrobial agents already compromise treatment effectiveness and control of Ng infections. The aim of this study was to know the susceptibility profiles of Ng isolates and clinical features of the patients treated at a public hospital located in the suburbs of Buenos Aires.MethodsWe studied 40 isolates of Ng recovered between 2014 and 2015 by the laboratory of bacteriology, from patients attending to the STD office of Eva Perón Hospital. Minimum inhibitory concentrations (MICs) were determined for penicillin (PEN), tetracycline (TET), ciprofloxacin (CIP), azithromycin (AZI), cefixime (CFX) and ceftriaxone (CRO) by agar dilution method (CLSI). B-lactamase was performed by chromogenic cephalosporin method (Nitrocefin).ResultsIsolates were recovered from: urethra (36), endocervix (3) and conjunctiva (1). Results of MIC 50 and MIC 90 (μg/ml) were: PEN 0.5 and 4; TET: 1 and 32; CIP: 1 and 4; AZI: 0.25 and 0.5; CFX: 0.016 and 0.03; CRO: 0.008 and 0.016. Isolates with combined resistance to CIP-AZI-PEN, PEN-TET-CIP and CIP-TET-AZI were observed. Cephalosporin resistant Ng isolates was not observed although 2 isolates with decreased susceptibility to CFX (MIC 0.125 µg/ml) were found. The patient medical records were reviewed and no epidemiological relation was found among the patients with harbours strains with simultaneous resistance and clinical features. Patients were treated with CRO 500 mg IM plus AZI 1 g. The post treatment clinical controls were negative.ConclusionThe finding of Ng strains with decreased susceptibility to third generation cephalosporins is a warning signal. In addition to this, the presence of isolates with resistance to different classes of antibiotics, support the need to strength surveillance studies, evaluate treatment failures and improve prevention strategies to control of gonorrhoea in our population.
Pseudomonas aeruginosa es uno de los principales patógenos que causa infecciones asociadas a la atención en salud (IAAS). Su capacidad de adaptación, diseminación, resistencia intrínseca a los antimicrobianos y de adquirir nuevos mecanismos a través de elementos genéticos móviles, hacen que el tratamiento de las infecciones por este microorganismo sea un desafío para el médico clínico. Intrínsecamente, P. aeruginosa, presenta una reducida permeabilidad en la membrana externa, debido a la expresión de bombas de expulsión, y una cefalosporinasa tipo AmpC inducible. Además, P. aeruginosa es capaz de adquirir nuevos determinantes de resistencia por transferencia horizontal en forma de casetes situados en integrones, y a su vez, localizados en transposones o plásmidos. Dentro de la resistencia enzimática que presenta P. aeruginosa destacan las β-lactamasas, incluyendo aquellas de espectro extendido (BLEE) y las carbapenemasas. Pero también enzimas modificadoras de los aminoglucósidos, haciendo que este microorganismo pueda presentar fenotipos de multi-resistencia (MDR), resistencia extrema (XDR) y panresistencia (PDR) a los antimicrobianos denominados antipseudomonas, incluyendo a las nuevas cefalosporinas con inhibidores de β-lactamasas.
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