Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

Streptococcus pneumoniae and Staphylococcus aureus cause significant morbidity and mortality worldwide. We investigated both the colonization and co-colonization characteristics for these pathogens among 250 healthy children from 2 to 5 years of age in Merida, Venezuela, in 2007. The prevalence of S. pneumoniae colonization, S. aureus colonization, and S. pneumoniae–S. aureus co-colonization was 28%, 56%, and 16%, respectively. Pneumococcal serotypes 6B (14%), 19F (12%), 23F (12%), 15 (9%), 6A (8%), 11 (8%), 23A (6%), and 34 (6%) were the most prevalent. Non-respiratory atopy was a risk factor for S. aureus colonization (p = 0.017). Vaccine serotypes were negatively associated with preceding respiratory infection (p = 0.02) and with S. aureus colonization (p = 0.03). We observed a high prevalence of pneumococcal resistance against trimethoprim–sulfamethoxazole (40%), erythromycin (38%), and penicillin (14%). Semi-quantitative measurement of pneumococcal colonization density showed that children with young siblings and low socioeconomic status were more densely colonized (p = 0.02 and p = 0.02, respectively). In contrast, trimethoprim–sulfamethoxazole- and multidrug-resistant-pneumococci colonized children sparsely (p = 0.03 and p = 0.01, respectively). Our data form an important basis to monitor the future impact of pneumococcal vaccination on bacterial colonization, as well as to recommend a rationalized and restrictive antimicrobial use in our community.

Background: Nontyphoid Salmonella (NTS) infections are a frequent cause of self-limited diarrhoeal illness in healthy children that do not usually require antibiotic treatment. This study was conducted by analyzing the phenotypic and genotypic traits of NTS strains from pediatric patients with acute gastroenteritis living in urban areas in the city of Mérida, Venezuela. Methodology: Thirty-seven Salmonella strains (18 S. Enteritidis; 14 S. Typhimurium; 2 S. Java; 2 S. Saintpaul; 1 S. Infantis) were isolated from 243 stool specimens. These strains were biochemically identified and serotyped. Antimicrobial susceptibility was determined by the disc-diffusion assay. Genetic characterization included plasmid profiling, PCR detection of the spv region and inv genes, and IS200 typing. Results: Thirty (81.0%) of the Salmonella isolates were resistant to the antimicrobial tested. Of these strains, 17 (56.7%) were resistant to at least one antibiotic. Five resistance patterns were observed, of which the most frequently found was the single type (tetracycline, streptomycin or ampicillin). All the S. Typhimurium harbored plasmids, but only three large plasmids (60, 72 and 84 kb) yielded amplicons with a spvR specific primers. All the Salmonella serotypes showed the presence of an inv region. Eight distinct IS200 profiles could be detected among the 37 Salmonella strains studied. Conclusions: Predominant Enteritidis and Typhimurium serotypes, as well as serotypes Java, Saintpaul and Infantis, are circulating in the city of Mérida, Venezuela. Most of these strains are susceptible to first-line antibiotics but active monitoring of isolates for antimicrobial resistance is necessary. IS200 typing, applied in association with conventional methods, allowed the characterization of all isolates and suggested the presence of different infection sources.

Four nontyphoidal Salmonella strains with resistance to extended-spectrum cephalosporins and nonclassical quinolone resistance phenotype were studied. Two S. Give were isolated from pediatric patients with acute gastroenteritis, and two S. Heidelberg were recovered from raw chicken meat. Phenotypic characterization included antimicrobial susceptibility testing and detection of extended-spectrum β-lactamases (ESBLs) by the double-disc synergy method. The detection of quinolone resistance-determining regions (QRDR) of gyrA, gyrB, and gyrC genes, bla ESBLs genes, and plasmid-mediated quinolone resistance (PMQR) determinants was carried out by molecular methods. Plasmid analysis included Southern blot and restriction patterns. Transferability of resistance genes was examined by transformation. bla TEM-1 + bla SHV-12 genes were detected in S. Give SG9611 and bla TEM-1 + bla CTX-M-2 in the other three strains: S. Give SG9811, S. Heidelberg SH7511, and SH7911. Regardless of origin and serovars, the qnrB19 gene was detected in the 4 strains studied. All determinants of resistance were localized in plasmids and successfully transferred by transformation. This study highlights the circulation of qnrB19 associated with bla TEM-1, bla SHV-12, and bla CTX-M-2 in S. Give and S. Heidelberg in Venezuela. The recognition of factors associated with increasing resistance and the study of the molecular mechanisms involved can lead to a more focused use of antimicrobial agents.

This is the first description of an outbreak of infection with this genospecies of Acinetobacter in which parenteral nutrition solution was potentially the infection source.