Extended spectrum β-lactamase producers among nosocomial Enterobacteriaceae in Latin America

Abstract

To review the epidemiology of nosocomial extended spectrum β-lactamase-producing Enterobacteriaceae in Latin America, a systematic search of the biomedical literature (PubMed) was performed for articles published since 2005. Rates of nosocomial infections caused by extended spectrum β-lactamase-producing Enterobacteriaceae in Latin America have increased since 2005. Up to 32% of Escherichia coli and up to 58% of Klebsiella pneumoniae isolates are extended spectrum β-lactamase-positive, rates that are higher than in other world regions. From a region-wide perspective, 11-25% of E. coli isolates and 45-53% of K. pneumoniae isolates were nonsusceptible to third-generation cephalosporins. At the country level, there was a wide range in Enterobacteriaceae resistance rates to third-generation cephalosporins, with especially high rates of resistance to E. coli in Guatemala, Honduras, and Mexico, and high resistance rates to Klebsiella spp. in Argentina, Brazil, Chile, Guatemala, Honduras, and Paraguay. Susceptibility of extended spectrum β-lactamase-producing Enterobacteriaceae to cefepime, fluoroquinolones, ampicillin/sulbactam, aminoglycosides, and piperacillin/tazobactam has also been compromised, leaving the carbapenems, tigecycline, and colistin as the only antibiotics with >90% susceptibility rates. There is a steady increase in the prevalence and types of extended spectrum β-lactamases produced by Enterobacteriaceae isolates in Latin American hospitals (particularly CTX-Ms), suggesting endemic conditions overlaid by clonal outbreaks. Appropriate treatment decisions and infection control strategies informed by surveillance of regional and local susceptibilities and mechanisms of resistance are required to mitigate this major public health concern.

Antimicrobial susceptibility among Gram-positive and Gram-negative organisms collected from the Latin American region between 2004 and 2015 as part of the Tigecycline Evaluation and Surveillance Trial

“…High frequencies of ESBL-producing Enterobacteriaceae have been reported in Latin America by previous surveillance studies, particularly K. pneumoniae and E. coli [2]. In this update we have shown the rate of these organisms to be 36.3% and 25.4%.…”

“…Sader et al [18] reported higher rates of ESBL-producing K. pneumoniae and E. coli (57.3 and 37.7%, respectively) from the SENTRY study of Latin American centers (2011–2014). Differences could be in part due to the different countries included in each study, and variable rates of ESBL production across Latin America have previously been reported [2]. Furthermore, the rates of ESBL production in this T.E.S.T.…”

Diseminación de Klebsiella pneumoniae productoras de KPC-3 en hospitales de Bogotá durante un periodo de tres años

“…Otros antibióticos, como la colistina y la tigeciclina, se utilizan para el tratamiento contra microorganismos portadores de carbapenemasas (20,21), y nuestros aislamientos presentaron sensibilidad in vitro frente a estos dos agentes. Sin embargo, actualmente ya hay reportes de aislamientos portadores de KPC resistentes a estos antibióticos en Estados Unidos (22), Europa (23,24) Asia (25) y, más recientemente, en Suramérica (26).…”

Prevalence and Sensitivity of Bacilli and Pseudomonas in the Newborn’s Oral Cavity

“…Species producing extended spectrum β-lactamases (ESBL), have been frequently observed, among them Klebsiella pneumoniae and Escherichia coli (5)(6)(7).…”