Resumen

SANTISTEBAN LARRINAGA, Yesleisy et al. Infections caused by Klebsiella y Acinetobacter genuses in Cuban pediatric hospitals and antimicrobial resistance. Rev Cubana Med Trop [online]. 2014, vol.66, n.3, pp. 400-414. ISSN 0375-0760.

Introduction: Klebsiella pneumoniae and the Acinetobacter baumannii-calcoaceticus complex represent important nosocomial pathogens worldwide. The patients admitted to the neonatology and the intensive care unit services suffer infections very frequently. Objectives: to characterize clinically and microbiologically Klebsiella and Acinetobacter isolates causing infections in Cuban pediatric hospitals. Methods: a descriptive longitudinal study of 152 clinical isolates (102 Klebsiella spp and 50 Acinetobacter spp), which caused nosocomial infections in children and were sent to the national reference laboratory of microbiology in "Pedro Kouri" Institute. The study was conducted from June 2011 to September 2012. The species were identified by biochemical tests. The susceptibility to 18 antimicrobials, the production of extended spectrum ?-lactamase (ESBL) and metallo-?-lactamases were determined according to the Clinical and Laboratory Standards Institute. Results: the most frequent infections in infants and children by Acinetobacter and Klebsiella were found in blood, endotracheal secretion and skin lesions.. Klebsiella pneumoniae (96 %) and Acinetobacter baumannii-calcoaceticus complexes (90%) were the most prevalent species and were frequently isolated in intensive care, neonatology and burned patient wards. Both pathogens showed high resistance to cephalosporins with 57 % of extended-spectrum betalactamase production in Klebsiella spp. Resistance to carbapenems was only detected in Acinetobacter (61 %) with 2 % of metallobetalactamse production. Acinetobacter spp. was more susceptible to tetracyclines and cholistin where Klebsiella spp was more susceptible to ciprofloxacin. In both pathogens, a high resistance to aminoglycosides (66% -75 %) and trimethoprim-sulfamethoxazole (45 %-60 %) was observed. Conclusions: Klebsiella pneumoniae and Acinetobacter baumannii-calcoaceticus complex represent a potential threat in pediatric services with few therapeutic options. The carbapenems remain the only alternative to severe infections caused by multidrug resistant Klebsiella spp and cholistin is the only choice to treat extreme multidrug resistant Acinetobacter spp infections.

Palabras clave : antimicrobial resistance; Klebsiella spp.; Acinetobacter spp.; Cuba.

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