Epidemiología clínica y molecular de las infecciones por Shigella spp en niños de la Región Metropolitana durante el verano 2004-2005

Abstract

Shigella spp infections in children living in the Metropolitan Region, Chile, during summer of 2004-2005 Background: Shigella spp is a frequent cause of diarrhea in children. Antimicrobials decrease the duration of diarrhea and pathogen excretion. However, the increasing resistance limits their therapeutic value. Aim: To study Shigella serotype distribution in the Metropolitan Region in Chile, and its relationship with severity of disease, antimicrobial resistance pattern and clonality. Material and methods: During summer 2004-2005, stool samples from children with diarrhea were collected in Cary Blair transport medium and cultured. Shigella isolates were serotyped using monoclonal and polyclonal commercial antibodies. In vitro activity of ampicillin, amoxicillin/clavulanic acid, chloramphenicol, cotrimoxazol, nalidixic acid, ciprofloxacin, ceftriaxone and azythromycin was determined by minimal inhibitory concentration (MIC). Clonality was studied by pulsed-field gel electrophoresis (PFGE) using XbaI as restriction enzyme. Results: One hundred thirty nine Shigella strains were isolated (77 S sonnei and 62 S flexneri). S sonnei and S flexneri 2a serotypes were responsible for 95% of episodes. Children aged 2-4 years, showed a greater incidence of Shigella infections and 77% of episodes were treated on an ambulatory basis. High resistance levels were observed for ampicillin, cotrimoxazole, amoxicillinclavulanic acid and chloramphenicol (67%, 60%, 56% and 45%, respectively). We found 11 resistance patterns and 61,2% of strains were multiresistant. There were multiple clones without a strict relationship with resistance patterns. Conclusions: Shigella infections in Metropolitan Region in Chile are associated to a restricted number of serotypes, representing a clonal expansion associated to different antimicrobial resistant patterns (

Patrones de susceptibilidad antimicrobiana de cepas de Shigella sonnei aisladas durante tres períodos diferentes en la Región Metropolitana, Chile

“…Shigella flexneri y S. sonnei son las especies prevalentes y endémicas en América Latina y en países industrializados 7 . En Chile, S. flexneri y S. sonnei, constituyen más de 80% de las cepas de Shigella aisladas, con una proporción similar entre ambas, predominando S. sonnei cada dos o tres años [8][9][10] . Investigaciones realizadas en niños chilenos, mostraron que un número reducido de serotipos (S. sonnei, S. flexneri 2a, S. flex-…”

“…Microbiología neri 2b y S. flexneri 6) son responsables de 90% de los episodios de shigelosis y que se mantienen relativamente estables en el tiempo 10 . En un informe emitido recientemente, el Instituto de Salud Pública de Chile (ISP) confirmó que S. sonnei es el serotipo prevalente en nuestro país con un incremento de 34% de cepas confirmadas durante el primer trimestre del año 2012, en comparación con igual período del año 2011 y de 68% respecto del año 2010 11 .…”

“…Estudios anteriores demostraron frecuencias de resistencia en cepas de Shigella para ampicilina (87%), cotrimoxazol (76%), tetraciclina (73%) y cloranfenicol (52%). Estas cifras coinciden con estudios internacionales, confirmando la globalización del problema 10 . Dado que el tratamiento con antimicrobianos reduce la transmisión, su utilización durante un brote puede representar una importante medida de salud pública.…”