Article information
Resumen
Los bacilos gramnegativos no fermentadores (BGNNF) de mayor relevancia clínica en los hospitales son Pseudomonas aeruginosa, Acinetobacter baumannii y Stenotrophomonas maltophilia, entre otros. Con frecuencia se trata de microorganismos capaces de causar diversos tipos de infección en pacientes hospitalizados y, sobre todo los dos primeros, de originar brotes clonales extensos y situaciones complejas en las que cepas esporádicas coexisten con cepas epidémicas. Algunas características comunes a todos ellos son su resistencia intrínseca a múltiples antibióticos, su capacidad para desarrollar más resistencias y la posibilidad de existencia de reservorios ambientales. El laboratorio de microbiología tiene un papel fundamental en la detección de posibles brotes causados por estos microorganismos, en la identificación de cepas con mecanismos de resistencia determinados y en la caracterización de la epidemiología local, mediante la detección de portadores y/o de reservorios ambientales, cuando proceda, la adecuada identificación de los aislados, el estudio fenotípico y/o la caracterización genotípica del mecanismo de resistencia, si procede, y, finalmente, mediante la utilización de las distintas técnicas de tipificación molecular de los aislados de BGNNF que se revisan en este artículo. Estas actividades se deben encuadrar dentro de los programas de vigilancia y control de patógenos resistentes en los hospitales y de los grupos multidisciplinares de control de la infección.
Palabras clave:
Pseudomonas aeruginosa
Acinetobacter baumannii
Stenotrophomonas maltophilia
Bacilos gramnegativos no fermentadores
Infección nosocomial
Epidemiología molecular
Brotes nosocomiales
Abstract
Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia are, among others, the most important nonfermentative Gram-negative bacilli within hospitals. These organisms are able to cause different types of nosocomial infections in predisposed patients, and P. aeruginosa and A. baumannii in particular may cause extensive clonal outbreaks and complex situations in which sporadic isolates may coexist with some epidemic strains. Some common features are their intrinsic resistance to many antimicrobials, their capacity to further develop antimicrobial resistance, and the possibility of environmental reservoirs as sources of these microorganisms in healthcare centers. The microbiology laboratory plays a key role in the detection of potential outbreaks, in the identification of new resistance mechanisms and in the characterization of local epidemiology, by detecting colonized patients and/or environmental reservoirs if needed, appropriately identifying the isolates, phenotypically or genotypically characterizing their mechanisms of resistance, if appropriate, and finally by using different molecular techniques for clonal typing, which are reviewed in this article. Such activities must be performed in the context of the surveillance and control programs of specific institutions and as part of the daily work of multidisciplinary infection control teams.
Keywords:
Pseudomonas aeruginosa
Acinetobacter baumannii
Stenotrophomonas maltophilia
Nonfermenter bacilli Gram negative
Nosocomial infection
Molecular epidemiology
Nosocomial outbreaks
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