Resistant gram-negative infections in the outpatient setting in Latin America

Abstract

Latin America has a high rate of community-associated infections caused by multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the literature over the last 10 years indicates that urinary tract infections (UTIs) by Escherichia coli, and intra-abdominal infections (IAIs) by E. coli and Klebsiella pneumoniae, were characterized by high rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and fosfomycin. In addition, preliminary data indicate an increase in IAIs by Enterobacteriaceae producing extended-spectrum β-lactamases, with reduced susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians in Latin America should recognize the public health threat associated with UTIs and IAIs by resistant Gram-negative bacteria. As the number of therapeutic options become limited, we recommend that antimicrobial prescribing be guided by infection severity, established patient risk factors for multidrug-resistant infections, acquaintance with local antimicrobial susceptibility data, and culture collection.

Fig. 1.

Prevalence (and type) of extended spectrum β-lactamases harboured by K. pneumoniae¹ and E. coli² in Latin American clinical isolates during the late 1990s [32].

Fig. 2.

Percentage (no. of isolates) of urinary tract E. coli isolates collected from (a) women and (b) men in Latin America (2010 PAHO report) that were resistant to trimethoprim/sulfamethoxazole¹, ciprofloxacin², and the second-generation cephalosporin cefuroxime³ [39]. * Data from the 2009 PAHO report [38] is given for this country because 2010 data were not reported; † all adults (women and men).

Fig. 3.

Antimicrobial susceptibilities of ESBL-producing E. coli and K. pneumoniae intra-abdominal isolates in Latin America (2002–2008). Susceptibilities are based on in vitro minimum inhibitory concentration data. (Reprinted from Villegas et al. [42], copyright © 2011, with permission from Elsevier.)

Fig. 4.

Proportion of E. coli isolates from intra-abdominal infections in Latin America that were extended-spectrum β-lactamase positive (SMART, 2008–2009) [43].