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Bacterias enteroinvasivas. Estudio local en atención clínica especializada
Enteroinvasive bacteria. Local study in specialized clinical care
María del Mar Martín-Rodrígueza, Jaime Borrego-Jiménezb, Enrique Rodríguez-Guerrerob, José Gutiérrez-Fernándezb,c,
Autor para correspondencia
josegf@go.ugr.es

Autor para correspondencia.
a Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, España
b Unidad de Gestión Clínica de Microbiología Clínica, Hospital Universitario Virgen de las Nieves-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, España
c Departamento de Microbiología, Universidad de Granada-Instituto de Investigación BioSanitaria-IBS-Granada, Granada, España
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cuando hubo punto de corte&#46; Se calcularon las frecuencias absolutas y relativas para las variables categ&#243;ricas&#44; y las medidas de tendencia central y dispersi&#243;n para las num&#233;ricas&#46; Se utiliz&#243; la prueba de &#967;<span class="elsevierStyleSup">2</span> para el an&#225;lisis estad&#237;stico de variables categ&#243;ricas y la de la t de Student para an&#225;lisis de variables num&#233;ricas&#44; como la edad&#46; Los datos se analizaron con el programa&#160;IBM&#174; SPSS&#174; Statistics&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el estudio se obtuvieron 9&#46;290 coprocultivos negativos y se aislaron 1&#46;160 microorganismos de 1&#46;080 &#40;10&#44;4&#37;&#41; episodios diferentes&#46; En general&#44; <span class="elsevierStyleItalic">Campylobacter</span> &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla adicional 1 en el anexo</a>&#41; es el m&#225;s aislado &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con <span class="elsevierStyleItalic">Campylobacter jejuni</span> como el m&#225;s frecuente&#46; El a&#241;o con mayor n&#250;mero de coprocultivos positivos fue 2017 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; seguido de 2019 &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla adicional 2 en el anexo</a>&#41;&#46; La frecuencia de <span class="elsevierStyleItalic">Campylobacter</span> aument&#243; en el &#250;ltimo a&#241;o &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#59; la de <span class="elsevierStyleItalic">Salmonella</span> fue mayor en 2017 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y <span class="elsevierStyleItalic">Aeromonas</span> se mantuvo estable &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;52&#41;&#46; <span class="elsevierStyleItalic">Campylobacter</span> y <span class="elsevierStyleItalic">Salmonella</span> fueron m&#225;s frecuentes en verano y en oto&#241;o &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002 y <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectivamente&#41;&#46; Hubo m&#225;s aislamientos en poblaci&#243;n infantil que en adultos &#40;60&#44;2 vs&#46; 39&#44;8&#37;&#41;&#44; a pesar de existir m&#225;s muestras de adultos &#40;69&#44;3 vs&#46; 30&#44;7&#37;&#41;&#44; por lo que la rentabilidad del coprocultivo es mayor en la poblaci&#243;n infantil &#40;15 vs&#46; 4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El 64&#44;8&#37; de <span class="elsevierStyleItalic">Campylobacter</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; el 54&#37; de <span class="elsevierStyleItalic">Salmonella</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41; y el 61&#44;1&#37; de <span class="elsevierStyleItalic">Aeromonas</span> se detectaron en poblaci&#243;n infantil &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; En menores de un a&#241;o&#44; <span class="elsevierStyleItalic">Campylobacter</span> fue la especie m&#225;s aislada&#44; seguida de <span class="elsevierStyleItalic">Aeromonas</span>&#46; En poblaci&#243;n adulta&#44; los pat&#243;genos m&#225;s frecuentemente aislados fueron los mismos que en la poblaci&#243;n pedi&#225;trica &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla adicional 3 en el anexo</a>&#41;&#46; En la mayor&#237;a de los pacientes se detect&#243; un &#250;nico pat&#243;geno&#44; en 56 pacientes se aislaron simult&#225;neamente 2&#59; de estos en el 96&#44;4&#37; de los episodios uno de los microorganismos fue <span class="elsevierStyleItalic">Aeromonas</span>&#46; El pat&#243;geno acompa&#241;ante m&#225;s habitual en la coinfecci&#243;n con <span class="elsevierStyleItalic">Aeromonas</span> fue <span class="elsevierStyleItalic">Campylobacter</span>&#46; El 85&#44;2&#37; de las coinfecciones con <span class="elsevierStyleItalic">Aeromonas</span> ocurrieron en ni&#241;os&#44; fundamentalmente menores de un a&#241;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La sensibilidad antibi&#243;tica se indica en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Destaca la baja sensibilidad de <span class="elsevierStyleItalic">Campylobacter</span> a ciprofloxacino&#44; dado que en algunos casos de diarrea aguda grave se inicia tratamiento emp&#237;rico con quinolonas&#44; y la infecci&#243;n por <span class="elsevierStyleItalic">Campylobacter jejuni</span> constituye el microorganismo detectado con mayor frecuencia en los coprocultivos&#46; En las <a class="elsevierStyleCrossRef" href="#sec0010">tablas adicionales 4 y 5 del anexo</a> aparecen los resultados de las sensibilidades a &#225;cido nalid&#237;xico y ciprofloxacino en <span class="elsevierStyleItalic">Salmonella</span>&#46; En general&#44; la susceptibilidad al &#225;cido nalid&#237;xico predijo con bastante precisi&#243;n la susceptibilidad a ciprofloxacino&#44; salvo en <span class="elsevierStyleItalic">Salmonella enterica</span> serogrupo B&#44; posiblemente debido a la presencia de fenotipos no cl&#225;sicos de resistencia a quinolonas en <span class="elsevierStyleItalic">S&#46; enterica</span> serogrupo B&#46; Para el estudio de la susceptibilidad a azitromicina se cont&#243; con 133 aislados de coprocultivos entre los a&#241;os 2016 y 2019 &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tablas adicionales 6&#44; 7 y 8 del anexo</a>&#41;&#46; En el an&#225;lisis de susceptibilidad a fosfomicina recuperamos 31 aislados de <span class="elsevierStyleItalic">Campylobacter coli</span>&#44; apreciando que las CMI eran elevadas &#40;<a class="elsevierStyleCrossRef" href="#sec0010">tabla adicional 9 del anexo</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; <span class="elsevierStyleItalic">Campylobacter jejuni</span> es el microorganismo m&#225;s frecuentemente aislado&#44; seguido de <span class="elsevierStyleItalic">Salmonella</span>&#44; que destacan en la poblaci&#243;n infantil&#46; Como antibi&#243;tico de primera elecci&#243;n frente a <span class="elsevierStyleItalic">Campylobacter</span> destaca eritromicina y las altas resistencias a ampicilina de <span class="elsevierStyleItalic">Salmonella</span> serogrupo B&#46; La sensibilidad al &#225;cido nalid&#237;xico predijo la susceptibilidad a ciprofloxacino de <span class="elsevierStyleItalic">Salmonella</span>&#44; salvo en <span class="elsevierStyleItalic">S&#46; enterica</span> serogrupo B&#46; Azitromicina puede considerarse una buena opci&#243;n de tratamiento emp&#237;rico de elecci&#243;n&#44; o alternativo en caso de multirresistencias a otros antibi&#243;ticos&#44; en las enteritis agudas graves producidas por las principales bacterias enteroinvasivas&#44; salvo en <span class="elsevierStyleItalic">Shigella</span>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Soporte econ&#243;mico del open access&#58; Universidad de Granada&#47;CBUA&#46;</p></li></ul></p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Fosfomicina CMI</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#8804;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">32</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#956;g&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
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es en pt

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos