Resistencia antimicrobiana en Klebsiella pneumoniae, Ecuador
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Vive Rev. Salud
Abstract
Klebsiella pneumoniae representa un gran desafío para los médicos y laboratoristas debido a su crecimiento acelerado, prevalencia en los entornos intrahospitalarios y la resistencia a los antibióticos. Este artículo, proporciona información sobre la vida evolutiva del microorganismo durante los últimos veinte años, así como puntos clave clínicos que se deben considerar para mejorar el manejo farmacológico del paciente, mediante la combinación de antibacterianos, conociendo los principales genes de resistencias y el mecanismo de virulencia. Objetivo. El objetivo de la presente investigación fue analizar la evolución de la resistencia antimicrobiana en Klebsiella pneumoniae a partir de la prevalencia de los principales mecanismos de resistencia que este patógeno presenta en Ecuador, durante el periodo 2000-2020. Materiales y métodos. Se realizó una revisión sistemática de la literatura científica de estudios observacionales, de resistencia antimicrobiana de cohorte retroprospectivo. Con base a la metodología PRISMA (Preferred Reportin Items for Systematic Reviews and Meta-Analyses. Resultados. La evolución de Klebsiella pneumonia durante los últimos veinte años destaca un incremento exponencial de los genes de resistenciaKPC-2, NDM y OXA-48 distribuidos principalmente en las ciudades de Quito, Guayaquil, Cuenca y Esmeralda. El gen KPC-2 se encuentra presente en todas las ciudades que reportan resistencia antimicrobiana para K. pneumonia, por lo tanto, es el gen de mayor prevalencia en el país causante de la falta de eficacia del tratamiento farmacológico. Conclusión. Se observa una rápida diseminación de los genes de virulencia y evolución en los mecanismos de resistencia reportados durante los veinte años de revisiones bibliográficas. Afectando geográficamente a las ciudades más importantes y de mayor tránsito poblacional. Además, hay una relación de los genes de mayor prevalencia (KPC-2) presentes mayoritariamente a nivel intrahospitalario. Estos hallazgos resaltan la importancia y duración de los programas de vigilancia epidemiológica y de resistencia antimicrobiana del Sistema de Salud.
Klebsiella pneumoniae represent a great challenge for doctors and laboratory workers due to their accelerated growth and prevalence in hospital settings and resistance to antibiotics. In this perspective article, it provides information on the evolutionary life of the microorganism during the last twenty years, as well as clinical key points that should be considered to improve the pharmacological management of the patient, through the combination of antibiotics, knowing the main resistance genes and the mechanism as such. Given the importance of this information, a manuscript is made, which will be detailed below. Objective. The objective of this research was to analyze the evolution of antimicrobial resistance in Klebsiella pneumoniae from the prevalence of the main resistance mechanisms that this pathogen presents in Ecuador, during the period 2000-2020. Materials and methods. A systematic review of the scientific literature of observational studies of antimicrobial resistance from a prospective cohort was carried out. Based on the PRISMA methodology. Results. the evolution of Klebsiella pneumonia during the last twenty years highlights an exponential increase in the resistance genes KPC-2, NDM and OXA-48 distributed mainly in the cities of Quito, Guayaquil, Cuenca and Esmeralda. The KPC-2 gene is present in all cities that report antimicrobial resistance for K. pneumonia, therefore, it is the most prevalent gene in the country, causing greater failure of drug treatment. Conclusion. A rapid dissemination of virulence genes and evolution in the resistance mechanisms reported during the twenty years of bibliographic reviews is observed. Geographically affecting the most important cities with the greatest population transit. In addition, there is a relationship of the KPC-2 genes with the highest prevalence, mainly present at the hospital level. These findings highlight the importance and duration of the epidemiological surveillance and antimicrobial resistance programs of the Health System.
Klebsiella pneumoniae represent a great challenge for doctors and laboratory workers due to their accelerated growth and prevalence in hospital settings and resistance to antibiotics. In this perspective article, it provides information on the evolutionary life of the microorganism during the last twenty years, as well as clinical key points that should be considered to improve the pharmacological management of the patient, through the combination of antibiotics, knowing the main resistance genes and the mechanism as such. Given the importance of this information, a manuscript is made, which will be detailed below. Objective. The objective of this research was to analyze the evolution of antimicrobial resistance in Klebsiella pneumoniae from the prevalence of the main resistance mechanisms that this pathogen presents in Ecuador, during the period 2000-2020. Materials and methods. A systematic review of the scientific literature of observational studies of antimicrobial resistance from a prospective cohort was carried out. Based on the PRISMA methodology. Results. the evolution of Klebsiella pneumonia during the last twenty years highlights an exponential increase in the resistance genes KPC-2, NDM and OXA-48 distributed mainly in the cities of Quito, Guayaquil, Cuenca and Esmeralda. The KPC-2 gene is present in all cities that report antimicrobial resistance for K. pneumonia, therefore, it is the most prevalent gene in the country, causing greater failure of drug treatment. Conclusion. A rapid dissemination of virulence genes and evolution in the resistance mechanisms reported during the twenty years of bibliographic reviews is observed. Geographically affecting the most important cities with the greatest population transit. In addition, there is a relationship of the KPC-2 genes with the highest prevalence, mainly present at the hospital level. These findings highlight the importance and duration of the epidemiological surveillance and antimicrobial resistance programs of the Health System.
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Vol. 4, No. 12