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Vol. 28. Núm. S1.
Programa Externo de Control de Calidad SEIMC. Año 2008
Páginas 12-18 (Enero 2010)
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Vol. 28. Núm. S1.
Programa Externo de Control de Calidad SEIMC. Año 2008
Páginas 12-18 (Enero 2010)
Acceso a texto completo
Betalactamasas de espectro extendido en enterobacterias distintas de Escherichia coli y Klebsiella
Extended-spectrum beta-lactamases in enterobacteria other than Escherichia coli and Klebsiella
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Cristina Seral García, María Pardos de la Gándara, Francisco Javier Castillo García??
Autor para correspondencia
fcastillo@salud.aragon.es

Autor para correspondencia.
Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza. Departamento de Microbiología, Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
Información del artículo
Resumen

Los métodos de detección de enterobacterias productoras de betalactamasas de espectro extendido (BLEE) comienzan por una adecuada interpretación de los perfiles de sensibilidad aplicando los criterios habituales de lectura interpretada del antibiograma. Posteriormente, se elegirán métodos de confirmación apropiados, basados en la inhibición de la enzima por inhibidores de betalactamasas, generalmente el ácido clavulánico. Deben utilizarse, al menos, dos sustratos –cefotaxima o ceftriaxona y ceftazidima– para detectar enzimas con baja actividad hidrolítica para alguno de los sustratos en las enterobacterias que no poseen AmpC, y añadir cefepima, o utilizar inhibidores de AmpC, en aquellos microorganismos que posean esta enzima. La identificación de las enzimas responsables del fenotipo BLEE confirmado puede realizarse, en el mismo laboratorio o en centros de referencia, siguiendo un protocolo de pruebas bioquímicas y moleculares que al menos permita descartar los genes relacionados con más frecuencia con los perfiles fenotípicos predominantes en nuestra región. Es importante conocer las combinaciones enzimas-microorganismos frecuentes en nuestra área geográfica, los vehículos de transmisión genética involucrados en su diseminación y las principales características epidemiológicas de las infecciones que producen para establecer la dimensión del problema y analizar su evolución, a fin de intentar instaurar medidas que contribuyan a limitar su diseminación.

Palabras clave:
Betalactamasas de espectro extendido
Métodos fenotípicos de cribado y confirmación
Métodos moleculares de caracterización
Abstract

Methods for detecting ESBL-producing Enterobacteriaceae begin by a correct interpretation of the susceptibility profiles, applying the usual criteria for interpretative reading of the antibiogram. Appropriate confirmatory methods will be consequently chosen, based on the inhibition of the enzyme by betalactamases inhibitors, generally clavulanic acid. In case of non-AmpC-producing Enterobacteriaceae, at least two substrates should be used –cefotaxime or ceftriaxone and ceftazidime– to detect enzymes with a low hydrolytic activity against both substrates. Cefepime or AmpC-inhibitors should be recommended for AmpC-producing microorganisms. The identification of the enzymes responsible for the confirmed ESBL phenotype can be performed, either in the clinical laboratory or in reference centres, following a protocol of biochemical and molecular reactions able to detect and characterize, at least, those genes more frequently related to the predominant phenotypic profiles in our region. It is important to know which are the most prevalent combinations enzyme-microorganism, the vehicles for the genetic transmission involved in their dissemination, and the main epidemiological characteristics of the infections that they produce, in order to establish the dimensions of the problem and conduct surveillance studies, with the aim of achieving measures to control the wide spread.

Keywords:
Extended spectrum beta-lactamases
Screening and confirmatory phenotypic methods
Molecular methods of detection
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