Resumen

MARTIN, G; CARMONA, O  y  GUZMAN, M. Nosocomial infection II: Resistance to ß-lactams and aminoglycosides in Pseudomonas aeruginosa at the Venezuelan medical centres (2000). Rev. Soc. Ven. Microbiol. [online]. 2003, vol.23, n.2, pp.183-189. ISSN 1315-2556.

Currently, between 5 and 10 percent of patients admitted to acute care hospitals acquire one or more infections in the hospital. A quarter of these nosocomial infections are originated in the intensive care unity (ICU), 20% of these are produced by antimicrobial agents resistant microorganisms; which is a global health problem by it self. This high degree of resistance is one of the reasons which contribute to increases the numbers of death by nosocomial infections. Gram-negative bacilli are the principals responsible of nosocomial infections, and among them, the first in frequency is P. aeruginosa. We compare the percentages of resistance to either ß-lactams or aminoglycosides in nosocomial (ICU and surgery=SU) and communitarian (Com) P. aeruginosa, at the Venezuelan Medical Centres, evaluating the differences between public (puC) and privates centres (priC) for the year 2000. It was used diffusion disk, according NCCLS. The software program WHONET was used. Statistical significance (p≤0,05-0,01) was determined by "Z". 1. We show significant differences in the frequency of resistance to ß-lactams (frb) in nosocomial P. aeruginosa from puC, between ICU/Com (major differences: piperacillin 44/ 8% and genta 39/ 10%), and between ICU/ Su (the major ≠ piperacillin 44/23%, and the minor ≠ cefepime 10/8%). 2. We observe a significant difference in frb, between puC and priC, in infections of patients from Su (majors ≠ : piper 23/15%, piper-tazob 11/2%, tobra 25/2%, netilm 25/8%, genta 37/22%, but not in those from ICU. 3. We did not found any difference in the P. aeruginosa resistant isolated to aminoglycosides between ICU and Su at the puC, but at the priC majors ≠ : tobra 40/1% and netilm 40/9%. 4. The differences in the fr to ß-lactams showed by P. aeruginosa infection are noteworthy between ICU and Su and between these and Com, either for puC or for priC. These observations support the implication of the environment, and specially the hospital environment in the dynamic of bacterial resistance, and then the necessity to take in account specials routine habit of asepsis and antisepsis measures. Moreover and due to the seriousness and high frequency, either for the infections or for the resistance produced by P. aeruginosa in this environment, demand the use in these patients, of specials pharmacological strategies; in order to ensure the success of the antimicrobial therapy, either to cure the infection or to prevent resistance