Tolerancia y heterorresistencia en microorganismos grampositivos
Tolerance and heteroresistance in Gram-positive microorganisms
María Isabel Morosini, Rafael Cantón
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Servicio de Microbiología y CIBER de Investigación en Salud Pública, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal,Unidad de Resistencia a Antibióticos y Virulencia Bacteriana asociada al Consejo Superior de Investigaciones Científicas (CSIC), Madrid, España
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Los fenómenos de tolerancia (evento genético por el cual una población bacteriana no muere o muere muy lentamente en presencia de un antimicrobiano bactericida), persistencia (estado fenotípico no heredable y transitorio por el que una subpoblación bacteriana [0,1–10%] sobrevive a concentraciones letales de un antimicrobiano con independencia de su mecanismo de acción) y heterorresistencia (fenómeno epigenético por el que se aíslan subpoblaciones isogénicas con menor sensibilidad cuando la población bacteriana se somete a concentraciones por encima del valor de la CMI) han sido en parte señalados como causantes de este hecho. Los nuevos antimicrobianos, entre ellos la daptomicina, se ven menos afectados por este tipo de fenómenos y deben considerarse de elección cuando se demuestre o sospeche su presencia.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">During the last few years, insufficient efficacy of currently recommended antimicrobial agents has been observed, mainly in the case of glycopeptides, during the treatment of infections due to methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>, even if these isolates show MIC values within the susceptible range. The phenomena associated with this observation are tolerance (a genetic event in which a bactericidal antibiotic fails to kill a bacterial population), persistence (a non-inherited and transient phenotypic phenomenon in which a bacterial subpopulation –0.1%-10%– survive lethal antimicrobial concentrations irrespective of the mechanisms of action) and heteroresistance (an epigenetic event in which less susceptible isogenic subpopulations are recovered when the entire population is challenged with concentrations exceeding MIC values). New antimicrobials, including daptomycin, are less affected by these phenomena and should be considered as the treatment of choice when these events are demonstrated or suspected.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:74 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 2 | 1 | 3 |
| 2020 Septiembre | 1 | 0 | 1 |
| 2017 Octubre | 38 | 9 | 47 |
| 2017 Septiembre | 60 | 21 | 81 |
| 2017 Agosto | 53 | 14 | 67 |
| 2017 Julio | 42 | 11 | 53 |
| 2017 Junio | 44 | 32 | 76 |
| 2017 Mayo | 89 | 31 | 120 |
| 2017 Abril | 34 | 30 | 64 |
| 2017 Marzo | 74 | 60 | 134 |
| 2017 Febrero | 86 | 32 | 118 |
| 2017 Enero | 49 | 11 | 60 |
| 2016 Diciembre | 64 | 15 | 79 |
| 2016 Noviembre | 82 | 15 | 97 |
| 2016 Octubre | 89 | 19 | 108 |
| 2016 Septiembre | 158 | 32 | 190 |
| 2016 Agosto | 57 | 29 | 86 |
| 2016 Julio | 50 | 12 | 62 |
| 2016 Junio | 26 | 23 | 49 |
| 2016 Mayo | 46 | 24 | 70 |
| 2016 Abril | 27 | 24 | 51 |
| 2016 Marzo | 34 | 24 | 58 |
| 2016 Febrero | 31 | 9 | 40 |
| 2016 Enero | 26 | 9 | 35 |
| 2015 Diciembre | 23 | 15 | 38 |
| 2015 Noviembre | 54 | 22 | 76 |
| 2015 Octubre | 50 | 16 | 66 |
| 2015 Septiembre | 29 | 14 | 43 |
| 2015 Agosto | 44 | 11 | 55 |
| 2015 Julio | 40 | 8 | 48 |
| 2015 Junio | 29 | 13 | 42 |
| 2015 Mayo | 25 | 9 | 34 |
| 2015 Abril | 33 | 13 | 46 |
| 2015 Marzo | 34 | 5 | 39 |
| 2015 Febrero | 17 | 8 | 25 |
| 2015 Enero | 46 | 3 | 49 |
| 2014 Diciembre | 40 | 6 | 46 |
| 2014 Noviembre | 32 | 3 | 35 |
| 2014 Octubre | 45 | 3 | 48 |
| 2014 Septiembre | 38 | 2 | 40 |
| 2014 Agosto | 51 | 4 | 55 |
| 2014 Julio | 42 | 4 | 46 |
| 2014 Junio | 38 | 3 | 41 |
| 2014 Mayo | 54 | 2 | 56 |
| 2014 Abril | 26 | 2 | 28 |
| 2014 Marzo | 23 | 3 | 26 |
| 2014 Febrero | 31 | 3 | 34 |
| 2014 Enero | 30 | 5 | 35 |
| 2013 Diciembre | 32 | 4 | 36 |
| 2010 Diciembre | 675 | 0 | 675 |
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