Abstract
Objetivo
Determinar la frecuencia de asociación entre Streptococcus pyogenes y bacterias productoras de betalactamasa en la faringoamigdalitis y evaluar su sensibilidad antimicrobiana in vitro.
Diseño
Estudio prospectivo, descriptivo y transversal.
Emplazamiento
El estudio de realizó en el Centro de Salud Dr. José Castro Villagrana, en Tlalpan, México, D.F., de enero de 1996 a febrero de 1999.
Pacientes
A 394 pacientes con diagnóstico de faringoamigdalitis se les aisló igual número de Streptococcus pyogenes, así como posibles bacterias productoras de betalactamasa.
Resultados
En 180 pacientes (45,7%), se aisló cuando menos una bacteria posible productora de betalactamasa. De éstos, en 138 pacientes (35% del total) se confirmó la presencia de al menos una bacteria productora de la enzima. En total se aislaron 218 bacterias reconocidas como productoras, y de éstas 152 (69,7%) resultaron betalactamasa positivas. No se encontraron cepas resistentes a antibióticos betalactámicos, mientras que un 9,6% fue resistente a eritromicina y el 45% a trimetoprimsulfametoxazol.
Conclusiones
Más de la tercera parte de los pacientes presentaron al menos una bacteria productora de betalactamasa. Streptococcus pyogenes continúa siendo 100% sensible in vitro a las penicilinas. El uso de la eritromicina no debe ser promovido como primera alternativa de terapia debido al notable incremento de cepas resistentes, lo que podría llegar a provocar dificultades en el tratamiento de pacientes alérgicos. Debido a su pobre actividad in vitro, el trimetoprim-sulfametoxazol no debe considerarse antibiótico de elección.
Palabras clave: Betalactamasas, Fallos tratamientos, Faringoamigdalitis, Penicilina, Streptococcus pyogenes
Abstract
Objective
To assess the frequency of association between Streptococcus pyogenes and betalactamase- producing-bacteria in the pharyngotonsillitis and the evaluate the in vitro susceptibility.
Design
Prospective, descriptive, transverse study.
Setting
The present study was carried out in the Health Center Dr. José Castro Villagrana, in Tlalpan, México, D.F., from Juanary, 1996 to February 1999.
Participants
In three hundred and ninety four patients with pharyngotonsillitis diagnosis we isolated the same number of Streptococcus pyogenes, and possible beta-lactamase-producing-bacteria.
Results
In 180 patients (45.7%) we isolated at least one possible beta-lactamase-producingbacteria. Of these, in 138 patients (35%) were confirmed the enzyme presence. In total, we isolated 218 possible beta-lactamase-producing bacteria, and 152 (69.7%) were beta-lactamase positive.We found no significant change in the in vitro susceptibility of group A Streptococcus to penicillin, but erythromycin resistance is relatively common, approximately 10% in this study.
Conclusions
Streptococcus pyogenes was uniformly susceptible to all penicillins and cephalosporins in vitro. Erythromycin treatment should not be promoted as first-line therapy because the consequent increase of bacterial resistance could create difficulty in treating penicillinallergic patients. Because of the poor activity of trimetoprimsulfametoxazol, this drug no longer can be considered the drug of choice for the management of group A Streptococcal infections.
Footnotes
Este trabajo se ha realizado con el apoyo económico del Departamento de Medicina Familiar de la UNAM.
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