Aminoglycoside Resistance Rates, Phenotypes, and Mechanisms of Gram-Negative Bacteria from Infected Patients in Upper EgyptReportar como inadecuado




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With the re-emergence of older antibiotics as valuable choices for treatment of serious infections, we studied the aminoglycoside resistance of Gram-negative bacteria isolated from patients with ear, urinary tract, skin, and gastrointestinal tract infections at Minia university hospital in Egypt. Escherichia coli mainly from urinary tract and gastrointestinal tract infections was the most prevalent isolate 28.57%, followed by Pseudomonas aeruginosa 25.7% mainly from ear discharge and skin infections. Isolates exhibited maximal resistance against streptomycin 83.4%, and minimal resistance against amikacin 17.7% and intermediate degrees of resistance against neomycin, kanamycin, gentamicin, and tobramycin. Resistance to older aminoglycosides was higher than newer aminoglycoides. The most common aminoglycoside resistance phenotype was that of streptomycin resistance, present as a single phenotype or in combination, followed by kanamycin-neomycin as determined by interpretative reading. The resistant Pseudomonas aeruginosa strains were capable of producing aminoglycoside-modifying enzymes and using efflux as mechanisms of resistance. Using checkerboard titration method, the most frequently-observed outcome in combinations of aminoglycosides with β-lactams or quinolones was synergism. The most effective combination was amikacin with ciprofloxacin 100% Synergism, whereas the least effective combination was gentamicin with amoxicillin 53.3% Synergistic, 26.7% additive, and 20% indifferent FIC indices. Whereas the studied combinations were additive and indifferent against few of the tested strains, antagonism was never observed. The high resistance rates to aminoglycosides exhibited by Gram-negative bacteria in this study could be attributed to the selective pressure of aminoglycoside usage which could be controlled by successful implementation of infection control measures.



Autor: Gamal F. Gad, Heba A. Mohamed, Hossam M. Ashour

Fuente: http://plos.srce.hr/



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