Uso de la terapia combinada en infecciones causadas por enterobacterias resistente a carbapenémicos desde un enfoque microbiológico: revisión sistemática

  • Nalleth D. Bolaño Ardila Universidad Popular del Cesar
Palabras clave: terapia combinada, carbapenémicos, concentración inhibitoria mínima, Enterobacteriaceae.

Resumen

Introducción: las carbapenemasas representan actualmente una amenaza para la salud humana en todo el mundo y constituirán uno de los problemas más difíciles de tratar en los próximos años. Objetivo: describir del uso de la terapia combinada con carbapenémicos en las infecciones por enterobacterias resistente a carbapenémicos desde un enfoque microbiológico. Materiales y Métodos: se realizó una revisión sistemática en PubMed sobre estudios en humanos y modelos de infección múridos, publicados entre 2010 y 2016 en inglés. Los estudios debían reportar los resultados de mortalidad asociada según el esquema de monoterapia y terapia combinada con carbapenémicos. La búsqueda para la selección de los estudios se basó en las palabras clave: “Carbapenem Resistance AND carbapenems”, “treatment and outcomes carbapenems enterobacteriaceae”, “Klebsiella pneumoniae”, “carbapenemase”, “Klebsiella pneumoniae AND combination therapy”. Resultados: se seleccionaron cinco estudios que incluyeron en total 1.313 pacientes con infecciones por enterobacterias resistentes a carbapenémicos y que proporcionaban información sobre el uso de la terapia combinada con carabapenémicos frente a la monoterapia en términos de las tasas de mortalidad asociada. Conclusiones: actualmente no se dispone de estudios clínicos controlados publicados en el tema, por lo que la elección del tratamiento antibiótico frente a las infecciones por enterobacterias resistentes a carbapenémicos aún es controvertida. La evidencia clínica emergente sugiere que el uso de la terapia combinada resulta beneficioso para este tipo de infecciones. Hoy en día los clínicos optan por reutilizar viejos antibióticos como las polimixinas, a pesar de la resistencia codificada por el gen mcr-1 adquirida por plásmidos.

 

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Biografía del autor/a

Nalleth D. Bolaño Ardila, Universidad Popular del Cesar

Microbióloga, especialista en Microbiología Clínica, MSc en Microbiología Clínica. Docente asociado, Universidad Popular del Cesar. Valledupar, Cesar.

Referencias bibliográficas

Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001; 45: 1151-1161.

https://doi.org/10.1128/AAC.45.4.1151-1161.2001

Villegas MV, Lolans K, Correa A, Suarez CJ, Lopez JA, Vallejo M, et al. First detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South America. Antimicrob Agents Chemother 2006; 50: 2880-2882.

https://doi.org/10.1128/AAC.00186-06

Rojas LJ, Mojica MF, Blanco VM, Correa A, Montealegre MC, De La Cadena E, et al. Emergence of Klebsiella pneumoniae Coharboring KPC and VIM Carbapenemases in Colombia. Antimicrob Agents Chemother 2013; 57: 1101-1102.

https://doi.org/10.1128/AAC.01666-12

Pasteran FG, Otaegui L, Guerriero L, Radice G, Maggiora R, Rapoport M, et al. Klebsiella pneumoniae Carbapenemase-2, Buenos Aires, Argentina. Emerg Infect Dis 2008; 14: 1178-1180.

https://doi.org/10.3201/eid1407.070826

Gomez SA, Pasteran FG, Faccone D, Tijet N, Rapoport M, Lucero C, et al. Clonal dissemination of Klebsiella pneumoniae ST258 harbouring KPC-2 in Argentina. Clin Microbiol Infect 2011; 17: 1520-1524.

https://doi.org/10.1111/j.1469-0691.2011.03600.x

Quinones D, Hart M, Espinosa F, Garcia S, Carmona Y, Ghosh S, et al. Emergence of Klebsiella pneumoniae clinical isolates producing KPC-2 carbapenemase in Cuba. New Microbes New Infect 2014; 2: 123-126.

https://doi.org/10.1002/nmi2.54

Garza-Ramos U, Barrios H, Reyna-Flores F, Sanchez-Perez A, Tamayo-Legorreta E, Ibarra-Pacheco A, et al. Characteristics of KPC-2-producing Klebsiella pneumoniae (ST258) clinical isolates from outbreaks in 2 Mexican medical centers. Diagn Microbiol Infect Dis 2014; 79: 483-485.

https://doi.org/10.1016/j.diagmicrobio.2014.05.010

Marquez C, Ingold A, Echeverria N, Acevedo A, Vignoli R, Garcia-Fulgueiras V, et al. Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization. New Microbes New Infect 2014; 2: 58-63.

https://doi.org/10.1002/nmi2.40

Peirano G, Seki LM, Val Passos VL, Pinto MC, Guerra LR, Asensi MD. Carbapenem-hydrolysing beta-lactamase KPC-2 in Klebsiella pneumoniae isolated in Rio de Janeiro, Brazil. J Antimicrob Chemother 2009; 63: 265-268.

https://doi.org/10.1093/jac/dkn484

Gregory CJ, Llata E, Stine N, Gould C, Santiago LM, Vazquez GJ, et al. Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant. Infect Control Hosp Epidemiol 2010; 31: 476-484.

https://doi.org/10.1086/651670

Li H, Zhang J, Liu Y, Zheng R, Chen H, Wang X, et al. Molecular characteristics of carbapenemase-producing Enterobacteriaceae in China from 2008 to 2011: predominance of KPC-2 enzyme. Diagn Microbiol Infect Dis 2014; 78: 63-65.

https://doi.org/10.1016/j.diagmicrobio.2013.10.002

Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2013; 13: 785-796.

https://doi.org/10.1016/S1473-3099(13)70190-7

Giani T, D'Andrea MM, Pecile P, Borgianni L, Nicoletti P, Tonelli F, et al. Emergence in Italy of Klebsiella pneumoniae sequence type 258 producing KPC-3 Carbapenemase. J Clin Microbiol 2009; 47: 3793-3794.

https://doi.org/10.1128/JCM.01773-09

Zagorianou A, Sianou E, Iosifidis E, Dimou V, Protonotariou E, Miyakis S, et al. Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010. Euro Surveill 2012; 17.

Naas T, Nordmann P, Vedel G, Poyart C. Plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC in a Klebsiella pneumoniae isolate from France. Antimicrob Agents Chemother 2005; 49: 4423-4424.

https://doi.org/10.1128/AAC.49.10.4423-4424.2005

Robustillo Rodela A, Diaz-Agero Perez C, Sanchez Sagrado T, Ruiz-Garbajosa P, Pita Lopez MJ, Monge V. Emergence and outbreak of carbapenemase-producing KPC-3 Klebsiella pneumoniae in Spain, September 2009 to February 2010: control measures. Euro Surveill 2012; 17.

Giani T, Pini B, Arena F, Conte V, Bracco S, Migliavacca R, et al. Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: results of the first countrywide survey, 15 May to 30 June 2011. Euro Surveill 2013; 18.

Bowers JR, Kitchel B, Driebe EM, MacCannell DR, Roe C, Lemmer D, et al. Genomic Analysis of the Emergence and Rapid Global Dissemination of the Clonal Group 258 Klebsiella pneumoniae Pandemic. PLoS One 2015; 10: e0133727.

https://doi.org/10.1371/journal.pone.0133727

Qi Y, Wei Z, Ji S, Du X, Shen P, Yu Y. ST11, the dominant clone of KPC-producing Klebsiella pneumoniae in China. J Antimicrob Chemother 2011; 66: 307-312.

https://doi.org/10.1093/jac/dkq431

Tseng IL, Liu YM, Wang SJ, Yeh HY, Hsieh CL, Lu HL, et al. Emergence of Carbapenemase Producing Klebsiella Pneumonia and Spread of KPC-2 and KPC-17 in Taiwan: A Nationwide Study from 2011 to 2013. PLoS One 2015; 10: e0138471.

https://doi.org/10.1371/journal.pone.0138471

Chen L, Mathema B, Chavda KD, DeLeo FR, Bonomo RA, Kreiswirth BN. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol 2014; 22: 686-696.

https://doi.org/10.1016/j.tim.2014.09.003

Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008; 29: 1099-1106.

https://doi.org/10.1086/592412

Navarro-San Francisco C, Mora-Rillo M, Romero-Gomez MP, Moreno-Ramos F, Rico-Nieto A, Ruiz-Carrascoso G, et al. Bacteraemia due to OXA-48-carbapenemase-producing Enterobacteriaceae: a major clinical challenge. Clin Microbiol Infect 2013; 19: E72-79.

https://doi.org/10.1111/1469-0691.12091

Mouloudi E, Protonotariou E, Zagorianou A, Iosifidis E, Karapanagiotou A, Giasnetsova T, et al. Bloodstream infections caused by metallo-beta-lactamase/Klebsiella pneumoniae carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol 2010; 31: 1250-1256.

https://doi.org/10.1086/657135

Zarkotou O, Pournaras S, Tselioti P, Dragoumanos V, Pitiriga V, Ranellou K, et al. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect 2011; 17: 1798-1803.

https://doi.org/10.1111/j.1469-0691.2011.03514.x

Souli M, Galani I, Antoniadou A, Papadomichelakis E, Poulakou G, Panagea T, et al. An outbreak of infection due to beta-Lactamase Klebsiella pneumoniae Carbapenemase 2-producing K. pneumoniae in a Greek University Hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis 2010; 50: 364-373.

https://doi.org/10.1086/649865

Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 2014; 58: 2322-2328.

https://doi.org/10.1128/AAC.02166-13

Satlin MJ, Jenkins SG, Walsh TJ. The global challenge of carbapenem-resistant Enterobacteriaceae in transplant recipients and patients with hematologic malignancies. Clin Infect Dis 2014; 58: 1274-1283.

https://doi.org/10.1093/cid/ciu052

Jeon JH, Lee JH, Lee JJ, Park KS, Karim AM, Lee CR, et al. Structural basis for carbapenem-hydrolyzing mechanisms of carbapenemases conferring antibiotic resistance. Int J Mol Sci 2015; 16: 9654-9692.

https://doi.org/10.3390/ijms16059654

Nordmann P, Poirel L, Walsh TR, Livermore DM. The emerging NDM carbapenemases. Trends Microbiol 2011; 19: 588-595.

https://doi.org/10.1016/j.tim.2011.09.005

Viale P, Giannella M, Lewis R, Trecarichi EM, Petrosillo N, Tumbarello M. Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections. Expert Rev Anti Infect Ther 2013; 11: 1053-1063.

https://doi.org/10.1586/14787210.2013.836057

Fattouh R, Tijet N, McGeer A, Poutanen SM, Melano RG, Patel SN. What Is the Appropriate Meropenem MIC for Screening of Carbapenemase-Producing Enterobacteriaceae in Low-Prevalence Settings? Antimicrob Agents Chemother 2016; 60: 1556-1559.

https://doi.org/10.1128/AAC.02304-15

Morrill HJ, Pogue JM, Kaye KS, LaPlante KL. Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections. Open Forum Infect Dis 2015; 2: ofv050.

https://doi.org/10.1093/ofid/ofv050

Chang YY, Chuang YC, Siu LK, Wu TL, Lin JC, Lu PL, et al. Clinical features of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in intensive care units: a nationwide multicenter study in Taiwan. J Microbiol Immunol Infect 2015; 48: 219-225.

https://doi.org/10.1016/j.jmii.2014.05.010

van Duin D, Kaye KS, Neuner EA, Bonomo RA. Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes. Diagn Microbiol Infect Dis 2013; 75: 115-120.

https://doi.org/10.1016/j.diagmicrobio.2012.11.009

Falagas ME, Karageorgopoulos DE, Nordmann P. Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes. Future Microbiol 2011; 6: 653-666.

https://doi.org/10.2217/fmb.11.49

Bogdanovich T, Adams-Haduch JM, Tian GB, Nguyen MH, Kwak EJ, Muto CA, et al. Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis 2011; 53: 373-376.

https://doi.org/10.1093/cid/cir401

Kaye KS, Pogue JM, Tran TB, Nation RL, Li J. Agents of Last Resort: Polymyxin Resistance. Infect Dis Clin North Am 2016; 30: 391-414.

https://doi.org/10.1016/j.idc.2016.02.005

Lombardi F, Gaia P, Valaperta R, Cornetta M, Tejada MR, Di Girolamo L, et al. Emergence of Carbapenem-Resistant Klebsiella pneumoniae: Progressive Spread and Four-Year Period of Observation in a Cardiac Surgery Division. Biomed Res Int 2015; 2015: 871947.

https://doi.org/10.1155/2015/871947

Arnold RS, Thom KA, Sharma S, Phillips M, Kristie Johnson J, Morgan DJ. Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria. South Med J 2011; 104: 40-45.

https://doi.org/10.1097/SMJ.0b013e3181fd7d5a

Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo-beta-lactamases: the quiet before the storm? Clin Microbiol Rev 2005; 18: 306-325.

https://doi.org/10.1128/CMR.18.2.306-325.2005

Livermore DM, Warner M, Mushtaq S, Doumith M, Zhang J, Woodford N. What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents 2011; 37: 415-419.

https://doi.org/10.1016/j.ijantimicag.2011.01.012

Daikos GL, Markogiannakis A, Souli M, Tzouvelekis LS. Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae: a clinical perspective. Expert Rev Anti Infect Ther 2012; 10: 1393-1404.

https://doi.org/10.1586/eri.12.138

República de Colombia, Instituto Nacional de Salud, Dirección Redes en Salud Pública, Subdirección Laboratorio Nacional de Referencia, Grupo de Microbiologia. 2016. Alerta por la primera detección de mcr-1 gen de resistencia a colistina en aislamientos de Salmonella entérica serovar Typhimurium y Escherichia coli de origen humano en Colombia. http://www.grebo.org/images/Alerta_Colombia_mcr1_salmonella_y_E_coli.pdf, accessed febrero 2016.

Petrosillo N, Giannella M, Lewis R, Viale P. Treatment of carbapenem-resistant Klebsiella pneumoniae: the state of the art. Expert Rev Anti Infect Ther 2013; 11: 159-177.

https://doi.org/10.1586/eri.12.162

Livermore DM, Mushtaq S, Warner M, Zhang JC, Maharjan S, Doumith M, et al. Activity of aminoglycosides, including ACHN-490, against carbapenem-resistant Enterobacteriaceae isolates. J Antimicrob Chemother 2011; 66: 48-53.

https://doi.org/10.1093/jac/dkq408

Castanheira M, Sader HS, Jones RN. Antimicrobial susceptibility patterns of KPC-producing or CTX-M-producing Enterobacteriaceae. Microb Drug Resist 2010; 16: 61-65.

https://doi.org/10.1089/mdr.2009.0031

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013; 39: 165-228.

https://doi.org/10.1007/s00134-012-2769-8

Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis 2012; 55: 943-950.

https://doi.org/10.1093/cid/cis588

Qureshi ZA, Paterson DL, Potoski BA, Kilayko MC, Sandovsky G, Sordillo E, et al. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother 2012; 56: 2108-2113.

https://doi.org/10.1128/AAC.06268-11

Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, Daikos GL. Treating infections caused by carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect 2014; 20: 862-872.

https://doi.org/10.1111/1469-0691.12697

Falagas ME, Rafailidis PI, Ioannidou E, Alexiou VG, Matthaiou DK, Karageorgopoulos DE, et al. Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients. Int J Antimicrob Agents 2010; 35: 194-199.

https://doi.org/10.1016/j.ijantimicag.2009.10.005

Lee GC, Burgess DS. Treatment of Klebsiella pneumoniae carbapenemase (KPC) infections: a review of published case series and case reports. Ann Clin Microbiol Antimicrob 2012; 11: 32.

https://doi.org/10.1186/1476-0711-11-32

Souli M, Galani I, Boukovalas S, Gourgoulis MG, Chryssouli Z, Kanellakopoulou K, et al. In vitro interactions of antimicrobial combinations with fosfomycin against KPC-2-producing Klebsiella pneumoniae and protection of resistance development. Antimicrob Agents Chemother 2011; 55: 2395-2397.

https://doi.org/10.1128/AAC.01086-10

Urban C, Mariano N, Rahal JJ. In vitro double and triple bactericidal activities of doripenem, polymyxin B, and rifampin against multidrug-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Antimicrob Agents Chemother 2010; 54: 2732-2734.

https://doi.org/10.1128/AAC.01768-09

Elemam A, Rahimian J, Doymaz M. In vitro evaluation of antibiotic synergy for polymyxin B-resistant carbapenemase-producing Klebsiella pneumoniae. J Clin Microbiol 2010; 48: 3558-3562.

https://doi.org/10.1128/JCM.01106-10

Tangden T, Hickman RA, Forsberg P, Lagerback P, Giske CG, Cars O. Evaluation of double- and triple-antibiotic combinations for VIM- and NDM-producing Klebsiella pneumoniae by in vitro time-kill experiments. Antimicrob Agents Chemother 2014; 58: 1757-1762.

https://doi.org/10.1128/AAC.00741-13

Daikos GL, Petrikkos P, Psichogiou M, Kosmidis C, Vryonis E, Skoutelis A, et al. Prospective observational study of the impact of VIM-1 metallo-beta-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections. Antimicrob Agents Chemother 2009; 53: 1868-1873.

https://doi.org/10.1128/AAC.00782-08

Akova M, Daikos GL, Tzouvelekis L, Carmeli Y. Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria. Clin Microbiol Infect 2012; 18: 439-448.

https://doi.org/10.1111/j.1469-0691.2012.03823.x

Oliveros-Navarro A, Uribe N, Sierra P, Jaimes F, González JM. Bacteriemia por enterobacterias resistentes a carbapenems. Un estudio transversal. Infectio 2015; 19: 60-66.

https://doi.org/10.1016/j.infect.2014.11.006

Lynch JP, 3rd, Clark NM, Zhanel GG. Evolution of antimicrobial resistance among Enterobacteriaceae (focus on extended spectrum beta-lactamases and carbapenemases). Expert Opin Pharmacother 2013; 14: 199-210.

https://doi.org/10.1517/14656566.2013.763030

Cómo citar
1.
Bolaño Ardila ND. Uso de la terapia combinada en infecciones causadas por enterobacterias resistente a carbapenémicos desde un enfoque microbiológico: revisión sistemática. Med. Lab. [Internet]. 1 de marzo de 2016 [citado 17 de octubre de 2021];22(3-4):165-80. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/75
Publicado
2016-03-01
Sección
Microbiología
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