Este abstract presentado en el ICAAC este año (en sesión el 20 de Septiembre) refleja que el problema de resistencias también está en primaria. A pesar de que Salud Pública en la provincia de Cádiz diga lo contrario. Cuando se desborden seguro que querrán actuaciones para ayer.
Antibiotic Resistance in Enterobacteriaceae UTI’s Isolates: An Update from the Northern Italy Community
Author Block: M. Caltagirone1, L. I. Bellazzi2, E. Nucleo1, M. Spalla1, A. Piazza1, I. Bitar1, F. Zara1, R. Baratto1, R. Migliavacca1, L. Pagani1; 1Univ. of Pavia, Pavia, Italy, 2SmeL of Vigevano A. O., Vigevano, Italy
Disclosure Block: M. Caltagirone, None.. L. I. Bellazzi, None.. E. Nucleo, None.. M. Spalla, None.. A. Piazza, None.. I. Bitar, None.. F. Zara, None.. R. Baratto, None.. R. Migliavacca, None.. L. Pagani, None.
Background: MDR and ESβL-producing Enterobacteriaceae complicate the UTI’s therapy; afterwards an high prevalence reported in hospital settings, such isolates are emerging in the community as well. The work aimed to investigate the prevalence of ESβL-producers in community settings. Methods: A total of 697 consecutive non replicate UTIs specimens from outpatients of the Lombardy area have been collected in the period June-October 2013 at the Vigevano Hospital Service medicine Laboratory. Species identification/antimicrobial susceptibilities were obtained using BD Phoenix System (2014 EUCAST breakpoints). ESβLs confirmatory tests for all the identified species, and PCR/sequencing for blaCTX-M-genes on Escherichia coli were performed at the Pavia University. Result:. Among the Enterobacteriaceae, the most represented species was E. coli (n=443/697; 63.5%) followed by Klebsiella pneumoniae and Proteus mirabilis (n=49/697; 7%) and K. oxytoca (n=15/697; 2.15%). Among the species, ESβL-production was detected in (n=107/443) 24,2% E. coli, (n=10/49) 20.4% P. mirabilis, (n=7/49) 14.3% K. pneumoniae and (1/15) 6.7% K. oxytoca. All the ESβL-producing E. coli resulted MDR, showing resistance to ciprofloxacin (87%), gentamicin (41%), nitrofurantoin (94%), trimethoprim (58%) and trimethoprim/sulfamethoxazole (57%). While P. mirabilis and K. pneumoniae strains were always carbapenems susceptible, two E. coli isolates resulted resistant. ESβLs characterization was performed on 12 E. coli isolates, selected as representative. Ten out of 12 and 2/12 of the above strains resulted positive for blaCTX-M-1 and blaCTX-M-14 genes respectively by PCR and sequencing. Conclusions: CTX-M-type enzymes have been worryingly spread in the most common uropathogenic species in community, despite low risk factors (72% of outpatients has not been subjected to antibiotic therapy nor hospitalized/catheterized in the three months before the urine collection). This dramatic ESβLs dissemination could reflect the occurrence of an underlying environmental reservoir: studies are needed to assess the role of alimentary chains, rivers and water wells in the ESβLs spread.