Guías para el uso racional de antibióticos ß-lactámicos: mecanismos de resistencia y su interpretación clínica
Arias, César A.
Biomédica : Revista del Instituto Nacional de Salud, 0120-4157, Vol.23, Num.2, 2003 p. 134-140
Instituto Nacional de Salud
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ß-lactams are the antibiotic compounds most widely used against hospital and community acquired infections. However, resistance has emerged in both Gram-positive and Gramnegative bacteria, limiting their therapeutic efficacy. The choice of appropriate treatment depends on analysis of susceptibility data that indicates a specific mechanism of resistance. Correct interpretation of susceptibility tests permits a rational approach to the resistance problem and selection of alternatives for treatment. The laboratory must first be able to identify accurately microorganisms to the species level and then test a minimum of relevant antimicrobials. ßlactam resistance in Enterobacteriaceae is mainly due to the production of plasmid or chromosomal encoded ß-lactamases. In Gram-negative non-fermenting bacteria, impermeability and efflux are relatively more important to the treatment selected. In Grampositive bacteria, resistance mechanisms can involve changes in penicillin-binding proteins (PBPs), production of new PBPs or synthesis of ß-lactamases. The range of therapeutic options must be based on the current status of local resistance mechanisms.
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