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

Epidemiol Infect. 2013 Dec;141(12):2459-72. doi: 10.1017/S095026881300191X. Epub 2013 Aug 7.

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology*
  • Drug Resistance, Bacterial*
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology*
  • Humans
  • Intraabdominal Infections / epidemiology
  • Intraabdominal Infections / microbiology
  • Latin America / epidemiology
  • Outpatients
  • Urologic Neoplasms / epidemiology
  • Urologic Neoplasms / microbiology

Substances

  • Anti-Bacterial Agents