Browsing by Author "Zurita Salinas, Lucía Jeannete"
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Active surveillance of candidemia in children from latin america: A key requirement for improving disease outcome.(2014) Zurita Salinas, Lucía Jeannete; Santolaya, María ElenaBackground: Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America. Method: Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010. Results: Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92–10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04–4.17, P = 0.04). Conclusions: To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.Item Metadata only Antimicrobial susceptibility of Cutibacterium acnes isolated from ecuadorian patients with acne vulgaris(2018-06-01) Dressendorfer Garcés, Luz María; Soliz Torres, María Fernanda; Zurita Salinas, Lucía Jeannete; Dressendorfer Garcés, Luz MaríaAntimicrobial resistance to Cutibacterium acnes has become a worldwide problem in the last century, but there are no previous studies on antibiotic susceptibility patterns of this bacterium in Ecuador. A total of 129 skin swabs were collected from patients with acne vulgaris (AV) attending the dermatology department of a hospital in Quito, Ecuador, from July to August 2015. The patients selected had received registered antimicrobial therapy on at least one occasion before sampling. Microbiological procedures were performed according to conventional methods. The species of isolates were identified using a mass spectrometer system (matrix-assisted laser desorption ionization time-offlight [MALDI-TOF]). Antibiotic susceptibility tests on isolated Cutibacterium were performed using an anaerobe-sensitive panel (ANO2; Thermo Fisher; TREK Diagnostic Systems Ltd., West Sussex, UK).Item Open Access Cefazolin high-inoculum effect in methicillin-susceptible Staphylococcus aureus from South American hospitals.(2013) Zurita Salinas, Lucía Jeannete; Rincón, SandraObjectives: Clinical failures with cefazolin have been described in high-inoculum infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) producing type A β-lactamase. We investigated the prevalence of the cefazolin inoculum effect (InE) in MSSA from South American hospitals, since cefazolin is used routinely against MSSA due to concerns about the in vivo efficacy of isoxazolyl penicillins. Methods: MSSA isolates were recovered from bloodstream (n = 296) and osteomyelitis (n = 68) infections in two different multicentre surveillance studies performed in 2001–02 and 2006–08 in South American hospitals. We determined standard-inoculum (105cfu/mL) and high-inoculum (107 cfu/mL) cefazolin MICs. PFGE was performed on all isolates that exhibited a cefazolin InE. Multilocus sequence typing (MLST) and sequencing of part of blaZ were performed on representative isolates. Results: The overall prevalence of the cefazolin InE was 36% (131 isolates). A high proportion (50%) of MSSA isolates recovered from osteomyelitis infections exhibited the InE, whereas it was observed in 33% of MSSA recovered from bloodstream infections. Interestingly, Ecuador had the highest prevalence of the InE (45%). Strikingly, 63% of MSSA isolates recovered from osteomyelitis infections in Colombia exhibited the InE. MLST revealed that MSSA isolates exhibiting the InE belonged to diverse genetic backgrounds, including ST5, ST8, ST30 and ST45, which correlated with the prevalent methicillin-resistant S. aureus clones circulating in South America. Types A (66%) and C (31%) were the most prevalent β-lactamases. Conclusions: Our results show a high prevalence of the cefazolin InE associated with type A β-lactamase in MSSA isolates from Colombia and Ecuador, suggesting that treatment of deep-seated infections with cefazolin in those countries may be compromised.Item Open Access Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries(2016-04-22) Zurita Salinas, Lucía Jeannete; Villegas, María VirginiaIntroduction: Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy. Methods: Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information. Results: A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7-9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1-13.7; p < 0.001) were independently associated with in-hospital mortality. Conclusions: This study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.Item Metadata only Characterization of a small outbreak of Salmonella enterica serovar Infantis that harbour CTX-M-65 in Ecuador(2016) Alcocer Negrete, Iliana del Rocío; Zurita Salinas, Lucía Jeannete; Alcocer Negrete, Iliana del RocíoDear Editor, Travellers’ diarrhoea (TD) is the foremost health problem contracted abroad by United States citizens, affecting between 20% and 60% of those travelling to developing countries (www.cdc.gov). The aim of this study was to report the first Salmonella spp. resistant to broad spectrum antibiotics reported in Ecuador. Identification and sensitivity profile were performed using VITEK2® compact (bioMérieux, USA). Serotype was confirmed by agglutination in the National Reference Laboratory, INSPI, Quito, Ecuador. Plasmid extraction was performed following the manufacturer’s instructions (Pure Yield Plasmid Miniprep System, Promega, United Kingdom). ERIC-PCR was performed following the conditions previously described. The PCR for amplification of the CTX-M gene was performed as previously described.2 Purification of the PCR amplification from the agarose gel was performed following the manufacturer’s instructions (Wizard® SV Gel and PCR Clean-Up System, Promega) and sequenced in Macrogen, South Korea. From a total of 28 strains of Salmonella spp. isolated in the laboratory (January 2014–July 2015), five isolates were of the same clone which presented high resistance to antibiotics. The identification and serotyping showed that the strain corresponded to Salmonella enterica serovar Infantis harbouring CTX-M-65. ERIC-PCR confirmed the isolates were of the same clone. This is the first time a CTX-M 65 has been found outside of Asia, highlighting the importance of a good antibiotic policy in all countries as resistance can be easily disseminated around the world due to travel and trade. The rate of food-borne diseases have increased since 2011, which could be due to better reporting, better detection, higher awareness of the importance of these diseases among medical professionals; nonetheless, it could also translate a real increase in prevalence. It is important to note that daily ingestion of street food has become rather common. Food is often sold from unsealed containers or trollies that leave it open to contamination and sun-exposed. In general, street food vendors have no access to facilities for good hand hygiene and, most importantly, regulations for food hygiene are not rigorously enforced. CTX-M-like enzymes have been previously reported in Salmonella spp. around the world, and also in Latin America3–5 where CTX-M-2 was isolated. The CTX-M-65 described in this study is most likely chromosomal as all plasmid extractions and transformations were negative. In this manuscript the authors report, for the first time, a clone strain of Salmonella Infantis harbouring CTX-M-65 that is circulating in Ecuador. Food-borne diseases, as in most developing countries, are a serious issue in Ecuador, as information about these diseases and the importance of hygiene are poorly disseminated, compounding the risk of transmission. Our findings underscore the importance of a good hygiene policy when manipulating food and the need to implement regulations and laws aiming at controlling food quality offered for sale to general public. Enforcement of hygienic control of food production and marketing is essential.Item Open Access Characterization of the first report of Mycobacterium timonense infecting an HIV patient in an Ecuadorian hospital.(2014) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteMycobacterium timonense is a non-tuberculous mycobacteria (NTM) described in southern France in 2009, and to our knowledge, not reported again as a human pathogen in indexed literature. The aim of this work was to characterize the first clinical isolate of M. timonense in Ecuador. Time of growth, biochemical tests, thin layer growth test, PCR-RFLP analysis of the hsp65 gene and MALDI-TOF spectra analysis were not able to identify the species. The species identification was achieved through sequencing of rrs, hsp65 and rpoB genes. The results highlight the necessity to set up a sequencing method to identify emerging NTM in Ecuadorian clinical facilities.Item Open Access Colistin-resistant Escherichia coli clinical isolate harbouring the mcr-1 gene in Ecuador(2016-06-22) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteColistin resistance mediated by the mcr-1 gene has been reported worldwide, but to date not from the Andean region, South America. We report the first clinical isolate of Escherichia coli harbouring the mcr-1 gene in Ecuador. The strain was isolated from peritoneal fluid from a 14-year-old male with acute appendicitis, and subjected to molecular analysis. The minimum inhibitory concentration of colistin for the strain was 8 mg/ml and it was susceptible to carbapenems but resistant to tigecycline. The strain harboured mcr-1 and blaCTX-M-55 genes and was of sequence type 609. The recognition of an apparently commensal strain of E. coli harbouring mcr-1 serves as an alert to the presence in the region of this recently described resistance mechanism to one of the last line of drugs available for the treatment of multi-resistant Gram-negative infections.Item Open Access Comparación entre el año 2005 y 2009 en la terapia antimicrobiana inicial en aislamientos de hemocultivos positivos de E.coli, S.aureus, K.pneumoniae, P.aeruginosa(PUCE - Quito, 2010) Andrade Vargas, Miguel Alejandro; Guerrero Gavilanes, Daniel Alejandro; Zurita Salinas, Lucía JeanneteEn la actualidad, la bacteriemia se encuentra dentro de las primeras 20 causas de mortalidad en nuestro país, y para el tratamiento oportuno de ello es necesario considerar la importancia de la historia clínica del paciente y además la participación del laboratorio de microbiología por medio del hemocultivo. El hemocultivo es una técnica utilizada para el diagnóstico y la detección de microorganismos en el torrente sanguíneo. La etiología y la susceptibilidad antimicrobiana de estos organismos cambian con el tiempo, por lo que es necesaria una revisión periódica y un análisis para el manejo racional y eficaz de estas infecciones. El principal objetivo de este estudio es determinar cuántos pacientes recibieron tratamiento empírico adecuado y comparar el cambio de esta conducta en los años 2.005 y 2.009, en pacientes con bacteriemia confirmada. Esta será una contribución a la comunidad médica en el Ecuador sobre los microorganismos más relevantes y de mayor incidencia y cuál es su tendencia a generar resistencia a los antibióticos. Lugar: Hospital Vozandes Quito, Laboratorio de Microbiología y Tuberculosis. Tipo de estudio Descriptivo Universo Todos los pacientes internados en el hospital Vozandes Quito con al menos un hemocultivo positivo y en los cuales se sospechaba de bacteriemia causada por S. aureus, E. coli, K. pneumoniae, P. aeruginosa. Muestra: 113 pacientes Variables: Cultivos bacterianos, terapia antimicrobiana empírica utilizada, variables demográficas, estado al alta, días de hospitalización. Resultados: Se estudiaron 113 cultivos bacterianos, de personas con un promedio de edad de 55 años y con 59% de mujeres. La mayoría de las enfermedades subyacentes estuvieron concentradas en Diabetes Mellitus Tipo 2 (DM2) e Hipertensión Arterial (HTA), todos los pacientes fallecidos tuvieron a la sepsis grave como complicación. Respecto del tratamiento antibiótico, el uso inadecuado del mismo llego a un 31%, y en aproximadamente la mitad de los casos hubo rotación de medicamento, además de que casi el 20% se recurrió a la multiterapia. El promedio de días de estancia hospitalaria fue de 6 días en los pacientes sin complicaciones y 11 días en los complicados (p0.01), además se encontró una relación significativa entre recibir cambio de antibiótico y desarrollar complicaciones (OR 2.9 (1.1-7.6) p 0.03). El análisis de la efectividad del tratamiento por años no brinda ningún resultado estadísticamente significativo ya que en los dos años esta cifra llegó a un 70%, pero nos indica la variabilidad que hubo en cuanto a la elección del tratamiento empírico.Item Metadata only Diagnóstico y tratamiento de la Infección por el virus de la Inmunodeficiencia Humana, infecciones oportunistas y trastornos relacionados(2020) Terán Terán, Rosa Nohemi; Suaste Pazmiño, Kathya Verónica; Araujo Lascano, Andrea Valeria; Gómez Jaramillo, Ana María; Jarrín Estupiñán, Miguel Eduardo; Miranda Maldonado, Hugo Enrique; Zurita Salinas, Lucía Jeannete; Tricallotis Guerra, Jennifer Adriana; Medina Medina, María Belén; Cevallos Salas, Nelson Ignacio; Bosquez Salazar, Ruth Marilú; Champang Castro, Yanina Yaqueline; Moreno Izquierdo, Cristina Elizabeth; Romero Carvajal, Juan José; García García, Mónica Alexandra; Morales Rojas, Humberto RodrigoDiagnóstico y tratamiento de la Infección por el virus de la Inmunodeficiencia Humana, infecciones oportunistas y trastornos relacionados, es el primero de su tipo en el país, siendo una exhaustiva revisión de la literatura científica relacionada con la infección por el virus del VIH. El valor del libro radica también en la vinculación que ha tenido la sociedad científica (Sociedad de Infectología capítulo Pichincha) y la academia (PYCE y el posgrado de Medicina Interna) para poder llevar adelante el trabajo de investigación, redacción y edición. Médicos apasionados por este tema y comprometidos por los pacientes, han unido esfuerzos para exponer en un solo texto, los temas clínicos mas trascedentes de la enfermedad; y además, brindan al colegiado médico un enfoque de abordaje y manejo integral. A lo largo de sus tres apartados se aborda desde los conceptos esenciales de la infección por el IIH, profundizando en la clínica y el manejo de esta enfermedad, para luego describir las infecciones oportunistas asociadas a la presencia del virus y la posible inmunodeficiencia. Finalmente, nos demuestra aquellas situaciones en las que el VIH tiene implicaciones en las distintas etapas de la vida, así como las estrategias relacionadas a la prevención de esta infección.Item Metadata only Draft Genome Sequence of a Metronidazole-Resistant Bacteroides fragilis Strain Isolated in Ecuador(2019) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteHere, we report the draft genome sequence of Bacteroides fragilis strain Z&Z143, a metronidazole-resistant bacterium isolated from a blood culture from an Ecuadorian patient hospitalized in a medical institution in Quito, Ecuador. We describe a new variant of the nim genes, which is associated with metronidazole resistance.Item Metadata only Epidemiología del SARS-CoV-2/COVID-19(2020-04) Erazo Checa, Carlos Vinicio; Romero Carvajal, Juan José; Zurita Salinas, Lucía Jeannete; Terán Terán, Rosa NohemíEn la ciudad de Wuhan, provincia de Hubei - China, en diciembre del 2019 se presentó un brote de 41 casos de neumonías sin una etiología conocida, alertándose de la misma el 31 de diciembre; estos casos tuvieron un nexo epidemiológico con un mercado local, el mismo que fue cerrado el 01 de enero del 2020. Las autoridades sanitarias de China iniciaron el proceso de vigilancia e investigación, y el 7 de enero identificaron como agente causal un nuevo beta coronavirus, al cual se logró secuenciar el 12 de enero y se observó que tenía una similitud genética superior al 80% con el virus SARS-CoV; causante del SARS durante el 2002 a 2003, por lo que se asumió que era una enfermedad transmitida desde un animal; al inicio pensaron que era el mismo que portaba el SARS-CoV, los Civets, pero de acuerdo a un estudio llevado a cabo, estos solo amplificaban el virus, siendo los portadores reales los murciélagos Rhinolopussinicus (1)(2)(3).Item Open Access Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey.(2013) Zurita Salinas, Lucía Jeannete; Nucci, MarcioBackground: The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America. Methods: We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized. Results: Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%. Conclusions: This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.Item Metadata only Escherichia coli hyperepidemic clone ST410-A harboring bla CTX-M-15 isolated from fresh vegetables in a municipal market in Quito-Ecuador(2018) Mena López, Santiago Roberto; Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteDissemination of Extended spectrum β-lactamases (ESBL) Enterobacteriaceae is a major medical threat. Vegetables and fruits, which are usually consumed raw, are a very suitable pathway for the spread of these bacteria from farm-to-fork. However, limited information exists regarding resistant bacteria and epidemic clones that are disseminated in vegetables and tap water in South America. We processed a total of 90 samples in triplicate of nine typically consumed raw vegetables from a central municipal market, and tap water samples were processed from twenty-one locations in Quito, Ecuador. The samples were analyzed for total coliforms and ESBL Enterobacteriaceae contamination using the dilution filtration method. ESBL Escherichia coli isolates were phenotypically and genotypically characterized. The water was free of Enterobacteriaceae, but all the vegetables and fruits (except for blackberries) presented total coliform counts. Watercress had the highest load of total coliforms (3.3 × 10E4). ESBL E. coli was detected in alfalfa, leaf lettuce and parsley/cilantro samples. Alfalfa had the highest load of ESBL E. coli/total coliforms (1/3.3 × 10E2). We identified E. coli ST44-A and ST410-A harboring blaCTX-M-15 downstream of ISEcp1. Alfalfa and parsley/cilantro were contaminated with hyperepidemic E. coli ST410-A, which was resistant to quinolones and harbored blaCTX-M-15. For the first time, we report ESBL E. coli ST410-A from vegetables and express an alert regarding the health risk this could represent.Item Open Access First description of Shigella sonnei Harbouring blaCTX-M-55 outside Asia(2016-08-24) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteShigella sonnei harbouring blaCTX-M-55 was isolated outside of Asia for the first time. The blaCTX-M-55 gene was found to be downstream of ISEcp1 and located in a ̴130-kb conjugative plasmid belonging to the I1 incompatibility group. The strain was recovered from a 7-year-old Ecuadorian girl with watery diarrhoea who had not travelled abroad. Recent local data describe the emergence of blaCTX-M-55 and other variants typically found in Asia in the Andean Region, suggesting that increased travel of humans and trade relationships with Asian countries are influencing the current Ecuadorian bacterial resistance situation.Item Metadata only Genetic diversity and drug resistance of Mycobacterium tuberculosis in Ecuador(2019-02) Alcocer Negrete, Iliana del Rocío; Zurita Salinas, Lucía Jeannete; Alcocer Negrete, Iliana del RocíoBackground: The genetic diversity of Mycobacterium tuberculosis in Quito, Ecuador is not well known. Objective: To investigate mutations related to drug resistance and bacterial genotypes in M. tuberculosis strains in Ecuador. Design: This was a retrospective study of M. tuberculosis isolates from 104 patients. Isolates were phenotypically resistant to rifampicin (RMP) and/or isoniazid (INH). The genotype was determined using 24-locus mycobacterial interspersed repetitive units-variable-number tandem repeats (MIRU-VNTR). Results: Isolates showed mutations in the rpoB and katG genes, and the inhA promoter. In rpoB, we found 13 genetic alterations at codons 511, 513, 514, 515, 516, 526 and 531. Forty-six (44.2%) RMP-resistant isolates belonged to codon 531. In katG, there were nine genetic alterations at codons 296, 312, 314, 315, 322, 324 and 351. Fifty-three (51%) INH-resistant isolates belonged to codon 315. Five mutations not previously described were identified in katG: Thr324Ser, Thr314Ala, Ala312Pro, Trp351Stop and deleted G at 296 codon. The Latin American Mediterranean (LAM) (33.7%) and Ghana (30.8%) lineages presented most of the main mutations observed. Conclusion: This is the first report from Ecuador; it describes five new mutations in katG and indicates that LAM is the most prevalent lineage.Item Open Access Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash.(2014) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteObjectives: Burkholderia cepacia has been linked to healthcare-associated infections and colonization caused by contamination of alcohol-free mouthwash used in patients undergoing mechanical ventilation. The purpose of our study was to establish the source of a clustering of healthcare- associated B. cepacia isolates in patients on mechanical ventilation in the intensive care unit (ICU). Methods: During April 2012 the Infection Control Committee became concerned when B. cepacia was isolated from tracheal aspirate cultures of three ICU patients. The medical records for the years 2011 and 2012 were reviewed to identify further cases. Cultures of potential reservoirs were done. Isolates from patients and an alcohol-free mouthwash were submitted to multilocus sequence typing (MLST) analysis and antimicrobial resistance testing. Results: Four patients with positive cultures for B. cepacia were identified before the review of the medical records for the years 2011 and 2012. Nine further cases were identified in the review, defined as a patient with pneumonia who had a culture of respiratory secretions that was positive for B. cepacia. Three were cases of infection and 10 were colonizations. All of the isolates from patients (J, K, L, and M) and mouthwash samples (B19, B20, and B21) were genetically identical by MLST analysis. Conclusions: Our findings strongly suggest that alcohol-free mouthwash solution intrinsically contaminated with B. cepacia was the source of these colonizations and infections involving adults in the ICU.Item Metadata only High prevalence of B2-ST131 clonal group among extended-spectrum β-lactamase-producing Escherichia coli isolated from bloodstream infections in Quito, Ecuador(2019-12) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteObjectives: The purpose of this study was to describe the clonal relationships and phylogroups of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) isolated from patients with bacteraemia in three hospitals in Quito, Ecuador. Methods: Between June 2013 and September 2014, a total of 4354 blood cultures were performed in three hospitals located in different areas of Quito. A BACTECTM system was used for blood culture, and the VITEK®2 system was used for species identification and in vitro antimicrobial susceptibility testing. The ESBL genotype, presence of the blaCTX-M, blaTEM and blaSHV genes, and the phylogenetic group of E. coli isolates was determined by PCR. Clonal groups were established by multilocus sequence typing (MLST). Results: Of 929 blood cultures positive for Gram-negative bacilli, 181 (19.5%) were positive for E. coli, representing the most frequent bacteraemia isolates in each hospital. Of the 181 E. coli isolates, 57 (31.5%) were ESBL-Ec. The main sources of ESBL-Ec bacteraemia were urinary tract infection (40; 70.2%), biliary tract infection (10; 17.5%) and other infections (7; 12.3%). The majority of ESBL-Ec isolates (39; 68.4%) from the three hospitals belonged to the virulent phylogenetic group B2, of which 36/39 (92.3%) were ST131 and 33/36 (91.7%) carried the blaCTX-M-15 gene. Conclusion: These results provide knowledge of the phylogenetic relationships of E. coli from bacteraemia in Ecuadorian patients. ST131 has emerged in ESBL-Ec, representing an important public-health problem because this multiresistant clone is considered to be a vehicle for the propagation of antimicrobial resistance genes and is a highly virulent, well-adapted human pathogen.Item Metadata only High quantities of multidrug-resistant Escherichia coli are present in the Machángara urban river in Quito, Ecuador(2020) Crespo Pérez, María Verónica; Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteUrban river pollution by multidrug-resistant (MDR) bacteria constitutes an important public health concern. Epidemiologically important strains of MDR Escherichia coli transmissible at the human-animal-environment interfaces are especially worrying. Quantifying and characterizing MDR E. coli at a molecular level is thus imperative for understanding its epidemiology in natural environments and its role in the spread of resistance in precise geographical areas. Cefotaxime-resistant E. coli was characterized along the watercourse of the major urban river in Quito. Our results showed high quantities of cefotaxime-resistant E. coli (2.7 × 103-5.4 × 105 CFU/100 mL). The antimicrobial resistance index (ARI) revealed the exposure of the river to antibiotic contamination, and the multiple antibiotic resistance index indicated a high risk of contamination. The blaCTX-M-15 gene was the most prevalent in our samples. Isolates also had class 1 integrons carrying aminoglycoside-modifying enzymes and folate pathway inhibitors. The isolates belonged to phylogroups A, B1 and D. Clonal complex 10 was found to be the most prevalent (ST10, ST44 and ST 167), followed by ST162, ST394 and ST46. Our study provides a warning about the high potential of the major urban river in Quito for spreading the epidemiologically important MDR E. coli.Item Open Access Integrones: plataformas bacterianas de recombinación genética y su influencia en la resistencia bacteriana.(2013) Zurita Salinas, Lucía Jeannete; Ortega Paredes, DavidLa gran plasticidad de los genomas bacterianos ha permitido su adaptación frente a la presión selectiva ejercida por la terapia con antibióticos; esta versatilidad se encuentra mediada por elementos genéticos que permiten la reorganización de genes y la diseminación de determinantes de resistencia por transferencia horizontal. Dentro de este contexto, los integrones juegan un papel importante al ser plataformas de recombinación sitio-específica con capacidad de incorporar y expresar genes en casete. Se han descrito gran número de genes en casete con capacidad de conferir resistencia a diversas familias de antimicrobianos. Dichas estructuras genéticas pueden incorporarse en los integrones y formar colecciones de genes que confieren multiresistencia a antibióticos. Los integrones se encuentran frecuentemente asociados a estructuras genéticas móviles como plásmidos y transposones lo cual los convierte en actores fundamentales para la dispersión horizontal intra e interespecífica de genes. Muchos de los arreglos de genes en casete descritos en América del Sur se relacionan con resistencia a familias de antibióticos de amplio uso clínico como β-lactámicos, quinolonas y aminoglucósidos lo cual produce un marcado incremento en el fracaso terapéutico, al proporcionar a los patógenos bacterianos una combinación de genes de resistencia a los compuestos más empleados en el tratamiento de infecciones bacterianas.Item Open Access Klebsiella pneumoniae productora de carbapenemasa tipo KPC-2: primer reporte en el Ecuador.(2012) Zurita Salinas, Lucía Jeannete; Zurita Salinas, Lucía JeanneteLa resistencia a carbapenemes es poco común. En 2001 se detectó por primera vez una cepa de Klebsiella pneumoniae productora de carbapenemasa (KPC) tipo 1. Se presenta el primer reporte de Klebsiella pneumoniae productora de KPC tipo 2 en el Ecuador. Se trató de un paciente masculino de 24 años de edad, que fue sometido a cirugía por glioblastoma multiforme en el Hospital Homero Castanier de la ciudad de Azogues. Duante la hospitalización presentó signos menóngeos y descompensación. El cultivo de secreción purulenta de la herida quirúrgica reportó el aislameinto de Klebsiella pneumoniae. La evolución no fue favorable y el paciente falleció por meningitis postquirúrgica y shock séptico. La identificación genotópica de la cepa se realizó mediante Reacción en Cadena de la Polimerasa y se determinó que era productora de carbapenemasa tipo 2. El caso reportado confirma la presencia de este nuevo tipo de mecanismo de resistencia en el país. Se requiere el esfuerzo conjunto de los equipos de salud para la rápida detección y contención de este tipo de bacterias.