- Email: [email protected]
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina
COMUNICACIÓN BREVE
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina An outbreak of Leclercia adecarboxylata bacteremia likely associated to contaminated heparin vials $QD/XFtD&RUUHD/X]0DUtD0D]R0yQLFD3DWULFLD9DOGHUUDPD$OHMDQGUD5HVWUHSR)DELiQ-DLPHV
Resumen
Leclercia adecarboxylataHVXQDHQWHUREDFWHULiFHDUHSRUWDGDRFDVLRQDOPHQWHFRPRXQJHUPHQRSRUWXQLVWDTXHFRPSURPHWHSDFLHQWHVFRQDOJ~Q WLSRGHLQPXQRVXSUHVLyQFRPRQHXWURSHQLDFLUURVLVRFiQFHU6HUHSRUWDXQEURWHGHFLQFRFDVRVGHEDFWHULHPLDSRUL. adecarboxylata en pacientes FRQGLYHUVDVFRQGLFLRQHVGHLQPXQRVXSUHVLyQSUREDEOHPHQWHDVRFLDGRFRQHOXVRGHYLDOHVGHKHSDULQDFRQWDPLQDGRV6HKDFHXQDUHYLVLyQDFWXDOL]DGDGHODOLWHUDWXUD\XQDGLVFXVLyQVREUHORVDVSHFWRVSDUWLFXODUHVGHOEURWH\GHOPLFURRUJDQLVPR Palabras clave:KHSDULQDLeclercia adecarboxylataEDFWHULHPLDEURWH
Abstract
Leclercia adecarboxylata LVSDUWRIWKH(QWHUREDFWHULDFHDHIDPLO\RFFDVLRQDOO\UHSRUWHGDVDQRSSRUWXQLVWPLFURRUJDQLVPLQSDWLHQWVZLWKDQ\NLQG RILPPXQRVXSSUHVVLRQDVQHXWURSHQLDFLUUKRVLVRUFDQFHU:HUHSRUWDQRXWEUHDNZLWKÀYHFDVHVRI Leclercia adecarboxylata EDFWHUHPLDLQSDWLHQWV ZLWKVHYHUDOLPPXQHFRQGLWLRQVPRVWOLNHO\DVVRFLDWHGWRFRQWDPLQDWHGKHSDULQYLDOV:HDOVRSUHVHQWDQXSGDWHGOLWHUDWXUHUHYLHZDQGGLVFXVVLRQ UHJDUGLQJWKHSDUWLFXODUFKDUDFWHULVWLFVRIWKHRXWEUHDNDQGWKHPLFURRUJDQLVP Keywords:KHSDULQ L. adecarboxylataEDFWHUHPLDRXWEUHDN
Introducción Leclercia adecarboxylataHVXQDEDFWHULDGHODIDPLOLD(QWHUREDFWHULDFHDHHQFRQWUDGDHQODÁRUD JDVWURLQWHVWLQDOQRUPDOGHDQLPDOHV\KXPDQRV (1) 6HKDFXOWLYDGRWDPELpQGHODSLHOGHLQGLYLGXRVVDQRVHODJXDORVDOLPHQWRVODOHFKH\HQ GLYHUVDVIXHQWHVDPELHQWDOHVFRPRUHVHUYDVGH JUDVDV\DFHLWHVLQGXVWULDOHV (OPLFURRUJDQLVPRHVFRVPRSROLWDSHURVXYHUGDGHURVLJQLÀFDGRFOtQLFR\VXYLUXOHQFLDQRVRQ FODURVGDGRHOHVFDVRQ~PHURGHSXEOLFDFLRQHV UHODFLRQDGDV FRQ HVWH WHPD (Q OD PD\RUtD GH FDVRVLQIRUPDGRVVHSUHVHQWDFRPRXQJHUPHQ RSRUWXQLVWDTXHFRPSURPHWHSDFLHQWHVFRQDO &RPLWpGH3UHYHQFLyQGH,QIHFFLRQHV+RVSLWDO3DEOR7REyQ8ULEH 0HGHOOtQ&RORPELD *UXSRGH)DUPDFRYLJLODQFLD+RVSLWDO3DEOR7REyQ8ULEH 0HGHOOtQ&RORPELD 8QLGDGGH,QYHVWLJDFLRQHV+RVSLWDO3DEOR7REyQ8ULEH 'HSDUWDPHQWRGH0HGLFLQD,QWHUQD8QLYHUVLGDGGH$QWLRTXLD 0HGHOOtQ&RORPELD
,QIHFWLR
J~QWLSRGHLQPXQRVXSUHVLyQFRPRQHXWURSHQLDFLUURVLVRFiQFHU\VXHOHDLVODUVHGHLQIHFFLRQHVSROLPLFURELDQDV (QHVWHUHSRUWHVHGHVFULEHXQEURWHGHEDFWHriemias por L. adecarboxylata SUREDEOHPHQWH DVRFLDGRDOXVRGHKHSDULQDSUHPH]FODGDFRQWDPLQDGDXWLOL]DGDSDUDSHUPHDELOL]DUORVDFFHVRV YHQRVRV FHQWUDOHV \ SHULIpULFRV \ VH SUHVHQWD DGHPiVXQDUHYLVLyQDFWXDOL]DGDGHODOLWHUDWXUD
Métodos y resultados (O KRVSLWDO GRQGH VH SUHVHQWDURQ ORV FDVRV HV XQD LQVWLWXFLyQ XQLYHUVLWDULD GH WHUFHU QLYHO GH FRPSOHMLGDGFRQFDPDVGHODVFXDOHVVRQ 5HFLELGR $FHSWDGR &RUUHVSRQGHQFLD $QD/XFtD&RUUHD&RPLWpGH3UHYHQFLyQGH ,QIHFFLRQHV+RVSLWDO3DEOR7REyQ8ULEH&DOOH%1Ĉ 0HGHOOtQ&RORPELD7HOpIRQR H[WHQVLyQ &RUUHR HOHFWUyQLFR DFRUUHD#KSWXRUJFR
Correa AL, Mazo LM, Valderrama MP, et al
GHFXLGDGRVLQWHQVLYRV&XHQWDFRQWRGDVODVHVSHFLDOLGDGHV PpGLFRTXLU~UJLFDV H[FHSWR REVWHWULFLD\HVDGHPiVXQFHQWURGHWUDVSODQWHVGH PpGXODyVHDKtJDGRULxyQ\PXOWLYLVFHUDO 6HLGHQWLÀFyHOFDVRtQGLFHHQXQDPXMHUGH DxRV FRQ GLDJQyVWLFR GH OHLRPLRVDUFRPD GH ~WHURHVWDGR,9FRQPHWiVWDVLVUHWURSHULWRQHDO \HQSURJUHVLyQSXOPRQDUTXHFRQVXOWyDO6HUYLFLR GH 8UJHQFLDV OD QRFKH GHO GH DEULO GH SRUXQDVHPDQDGHHYROXFLyQGHÀHEUH\ HVFDORIUtR /D SDFLHQWH HVWDED HQ WUDWDPLHQWR FRQ TXLPLRWHUDSLD GHVGH HO GH IHEUHUR GHO PLVPR DxR IHFKD HQ OD TXH VH OH LPSODQWy XQ FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD\GtDV DQWHVGHODFRQVXOWDKDEtDUHFLELGRXQWHUFHUFLFORGHTXLPLRWHUDSLD (QODYDORUDFLyQLQLFLDOGHXUJHQFLDVQRVHGHWHFWyXQIRFRHYLGHQWHGHLQIHFFLyQ HOUHFXHQWRGH EODQFRVDOLQJUHVRHUDGHOHXFRFLWRVWRWDOHV FRQ GH SROLPRUIRQXFOHDUHV QHXWUyÀORV \ GHVSXpVGHPLQXWRVGHWRPDGRVORVKHPRFXOWLYRVDWUDYpVGHOFDWpWHUFHQWUDOGHLQVHUFLyQ SHULIpULFD VH GHWHFWy FUHFLPLHQWR GH XQ EDFLOR JUDPQHJDWLYR (O GH PD\R VH KL]R HO UHSRUWH GHÀQLWLYR GH FUHFLPLHQWR GH L. adecarboxylata \ QR VH REWXYR FUHFLPLHQWR GH JHUPHQ HQ ORV RWURVGRVFXOWLYRVWRPDGRVVLPXOWiQHDPHQWHGH VDQJUHSHULIpULFD'HVGHHOLQJUHVRSRUXUJHQFLDV VHLQLFLyWUDWDPLHQWRHPStULFRFRQSLSHUDFLOLQD WD]REDFWDP\HOFDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFDVHUHWLUyHOGHPD\R/DSDFLHQWHHVWXYR HVWDEOH GXUDQWH WRGD VX KRVSLWDOL]DFLyQ QR UHTXLULyPDQHMRHQFXLGDGRFUtWLFR\IXHGDGDGH DOWDHQEXHQDVFRQGLFLRQHVHOGHPD\R (OPLVPRGHPD\RHO/DERUDWRULRGH0LFURELRORJtD LQIRUPy FUHFLPLHQWR GH L. adecarboxylata HQ XQ KHPRFXOWLYR WRPDGR SRU FDWpWHU GH FiPDUD LPSODQWDEOH HQ XQ QLxR GH DxRV FRQ GLDJQyVWLFRGHOHXFHPLDOLQIRLGHDJXGD(OQLxR HVWDEDKRVSLWDOL]DGRGHVGHHOGHDEULOSRUUHFDtGD GH VX OHXFHPLD UHFLELHQGR TXLPLRWHUDSLD GH UHVFDWH \ \D KDEtD SUHVHQWDGR XQ HSLVRGLR GH QHXWURSHQLD IHEULO FRQ FXOWLYRV QHJDWLYRV \
$62&,$&,Ï1&2/20%,$1$'(,1)(&72/2*Ë$
WUDWDPLHQWRHPStULFRFRQFHIHSLPHHQWUHHO\ HOGHHVHPHV(OGHPD\RSUHVHQWyQXHYR HSLVRGLRGHQHXWURSHQLDIHEULOFRQOHXFRFLWRV WRWDOHV SRU OR TXH VH VROLFLWDURQ KHPRFXOWLYRV WRPDGRV D WUDYpV GHO FDWpWHU GH FiPDUD LPSODQWDEOH 1 \ GH VDQJUH SHULIpULFD 1 /XHJRGHPLQXWRVGHLQFXEDFLyQGHOKHPRFXOWLYR WRPDGR D WUDYpV GHO FDWpWHU VH REWXYR FUHFLPLHQWRGHPantoeaVSS\L. adecarboxylata. $OWUDWDPLHQWRLQLFLDGRHOGHPD\RFRQFHIHSLPH VH DJUHJy SRVWHULRUPHQWH FOLQGDPLFLQD \ DPLNDFLQD HO FDWpWHUGHFiPDUDLPSODQWDEOH VH UHWLUyHOGHPD\R\HOQLxRIXHGDGRGHDOWDHQ EXHQDVFRQGLFLRQHVHOGHPD\R $QWHHOKDOOD]JRHQXQPLVPRGtDHQPXHVWUDVGH KHPRFXOWLYRV GH GRV SDFLHQWHV GLIHUHQWHV GH XQ JHUPHQ QR FRQRFLGR SUHYLDPHQWH HQ OD LQVWLWXFLyQVHKL]RXQDUHYLVLyQH[KDXVWLYDGHWRGRVORV UHVXOWDGRV PLFURELROyJLFRV UHSRUWDGRV FRQ DQWHULRULGDG$QWHVGHOGHPD\RVyORVHHQFRQWUyXQ UHSRUWHGHOGHDEULOGHHVHDxRHQXQKHPRFXOWLYR SRVLWLYR SDUD L. adecarboxylata, WRPDGR SRUFDWpWHUGHFiPDUDLPSODQWDEOHHQXQDQLxDGH DxRVFRQGLDJQyVWLFRGHDQHPLDGH'LDPRQG %ODFNIDQ GHVGH ORV PHVHV GH HGDG KLSRSODVLD VHOHFWLYD GH JOyEXORV URMRV DGHPiV GH GLDEHWHV PHOOLWXV WLSR KLSHUWHQVLyQ SXOPRQDU \ VRUGHUD QHXURVHQVRULDO /D SDFLHQWH WHQtD HO FDWpWHU GH FiPDUDLPSODQWDEOHGHVGHHOGHGLFLHPEUHGH SRUODQHFHVLGDGGHWUDVIXVLRQHVDUHSHWLFLyQ \ OD PXHVWUD GHO GH DEULO WRPDGD SDUD HO KHPRFXOWLYR VH KL]R FRPR SDUWH GH XQ FRQWURO PLFURELROyJLFRSRUXQHSLVRGLRSUHYLRGHEDFWHULHPLD DVRFLDGD D FDWpWHU GDGR TXH SDUD HVD IHFKD QR VH UHIHUtDQ VtQWRPDV QL VLJQRV TXH VXJLULHVHQ LQIHFFLyQ&RQODHYROXFLyQFOtQLFDVDWLVIDFWRULDGH OD QLxD HO UHVXOWDGR IXH LQWHUSUHWDGR FRPR FRQWDPLQDFLyQ SRU OR TXH QR VH UHDOL]DURQ FDPELRV HQHOHVTXHPDDQWLELyWLFRLQLFLDGRDQWHULRUPHQWH SDUDJUDPSRVLWLYRV\ODSDFLHQWHIXHGDGDGHDOWD HQEXHQDVFRQGLFLRQHVHOGHDEULO3RVWHULRUDO GHPD\RVHGRFXPHQWDURQGRVFDVRVDGLFLRQDOHV HQ PXHVWUDV GH VDQJUH WRPDGDV HO GH PD\R \ HOGHPD\RWDPELpQHQSDFLHQWHVFRQGLYHUVDV FRQGLFLRQHVGHLQPXQRVXSUHVLyQ WDEOD
,QIHFWLR
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina Tabla 1. 3ULQFLSDOHVFDUDFWHUtVWLFDVGHORVFLQFRFDVRVGHEDFWHULHPLDSRULeclercia adecarboxylata Edad (años)
Sexo
Femenino
51
Femenino
5
0DVFXOLQR
74
Femenino
&LUURVLV\ KHSDWRFDUFLQRPD
65
0DVFXOLQR
&iQFHUGHFROyQHVWDGR ,9
Diagnóstico inicial
Síntomas previos
Tipo de muestra
&&,
3LSHUDFLOLQD WD]REDFWDP\ vancomicina
Vivo
3LSHUDFLOLQD WD]REDFWDP
Vivo
$QHPLDGH'LDPRQG %ODFNIDQ
1LQJXQR
/HLRPLRVDUFRPDGH ~WHURHVWDGR,9
)LHEUH HVFDORIUtRV
3,&&
/HXFHPLDOLQIRLGHDJXGD
)LHEUH HVFDORIUtRV WHPEORU
&&,
0DOHVWDU JHQHUDO DGLQDPLD
Vena SHULIpULFD
)LHEUH HVFDORIUtRV VXGRUDFLyQ
3,&&
Tratamiento antibiótico
Estado vital al alta
Recuento de leucocitos
&HIHSLPH Vivo $PSLFLOLQD VXOEDFWDP
0XHUWR
1LQJXQR 0XHUWR
&&, FDWpWHUGHFiPDUDLPSODQWDEOH 3,&& FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD
$SDUWLUGHORVGRVFDVRVDGLFLRQDOHVLGHQWLÀFDGRV\HYDOXDGRVVHLQWHUURJyGHQXHYRDODSDFLHQWHGHOFDVRtQGLFHVREUHVXHQIHUPHGDGDFWXDO/DSDFLHQWHUHODFLRQDEDFODUDPHQWHODDSDULFLyQGHORVHSLVRGLRVGHÀHEUH\HVFDORIUtRFRQ ODDSOLFDFLyQGHORVERORVGHKHSDULQDLQGLFDGRV DPEXODWRULDPHQWHSDUDPDQWHQHUSHUPHDEOHHO FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD (QHOSHULRGRFRUUHVSRQGLHQWHDOEURWHHVWDEDQ FLUFXODQGRHQODLQVWLWXFLyQFLQFRORWHVGLIHUHQWHV GHYLDOHVGHKHSDULQDSUHPH]FODGDGHODPDUFD $\XQORWHGHODPDUFD%7RGRVORVORWHVVHUHWLUDURQGHORVGLIHUHQWHVVHUYLFLRVGHOKRVSLWDO\ GHODIDUPDFLD\VHHQYLDURQGLIHUHQWHVPXHVWUDV SDUD FXOWLYR DO ODERUDWRULR GH OD LQVWLWXFLyQ \ D XQODERUDWRULRLQGHSHQGLHQWH&DGDODERUDWRULR UHFLELySDUDORVDQiOLVLVGLIHUHQWHVYLDOHVDXQTXH FRUUHVSRQGLHQWHVDOPLVPRORWH/RVUHVXOWDGRV HYLGHQFLDURQ FUHFLPLHQWR GH GLYHUVRV PLFURRUJDQLVPRVHQWUHHOORVL. adecarboxylataHQDOJXQDVGHODVPXHVWUDVUHFROHFWDGDV WDEOD (OSURFHGLPLHQWRDFWXDOGHOKRVSLWDOQRSHUPLWH HO UHJLVWUR \ HO VHJXLPLHQWR LQGLYLGXDO GH FDGD XQLGDG GH PHGLFDPHQWR GHVGH TXH LQJUHVD D ODIDUPDFLDKDVWDVXGLVSRVLFLyQÀQDO\DVHDXQ SDFLHQWHGHWHUPLQDGRGHYROXFLyQDODIDUPDFLD RGHVHFKRUD]yQSRUODTXHHVLPSRVLEOHGHWHUPLQDUTXpORWHVHDSOLFyDFDGDSDFLHQWH/RTXH
,QIHFWLR
VtHVFODURHVTXHWRGRVORVSDFLHQWHVFRQDFFHVR YHQRVRSHULIpULFRRFHQWUDOHVWXYLHURQHQULHVJRGHHVWDUH[SXHVWRVDORVYLDOHVFRQWDPLQDGRV $GHPiVQRVHDOPDFHQDURQODVFHSDVGHL. adecarboxylata TXH VH REWXYLHURQ GH ODV PXHVWUDV GHVDQJUHGHORVSDFLHQWHVSRUORTXHQRHVSRVLEOHGHWHUPLQDUODHSLGHPLRORJtDPROHFXODUGH GLFKDV FHSDV QL VX SRWHQFLDO FRQFRUGDQFLD FRQ ODVFHSDVREWHQLGDVGHODVPXHVWUDVGHKHSDULQD3RUORDQWHULRU\DSHVDUGHQRKDEHUWHQLGR QXHYRVHSLVRGLRVGHEDFWHULHPLDSRUL. adecarboxylata GHVSXpV GH PHVHV GH UHWLUDU WRGRV ORVORWHVGHKHSDULQDQRSRGHPRVHVWLPDUFRQ H[DFWLWXG \ SUHFLVLyQ XQD UHODFLyQ FDXVDO HQWUH ODKHSDULQD\ORVHSLVRGLRVLQIHFFLRVRVGHVFULWRV Revisión de la literatura y discusión Leclercia adecarboxylata HV XQ EDFLOR SHTXHxR TXH FUHFH ELHQ HQ ORV PHGLRV XVDGRV SDUD OD EDFWHULRORJtD GH ORV EDFLORV HQWpULFRV /OHYD VX QRPEUH HQ KRQRU D + /HFOHUF EDFWHULyORJR IUDQFpV TXLHQ HQ UHFRQRFLy XQD EDFWHULD TXHGHVFULELyFRPR´EDFWHULDFROLIRUPHSLJPHQWDGDGHDPDULOORµTXHHUDVLPLODUDE. coliHQODV UHDFFLRQHV,09L&SHURGLIHUtDSRUODSURGXFFLyQ GHXQSLJPHQWRDPDULOOR\VXFDSDFLGDGGHIHUPHQWDU YDULRV D]~FDUHV (7) ,QLFLDOPHQWH /HFOHUF SURSXVR TXH VH UHFRQRFLHUD FRPR XQD HVSHFLH DSDUWH GHQWUR GHO JpQHUR Escherichia como E.
Correa AL, Mazo LM, Valderrama MP, et al Tabla 2.5HVXOWDGRVGHORVHVWXGLRVPLFURELROyJLFRVHQODVPXHVWUDV GHKHSDULQD /RWHPXHVWUD
Laboratorio 1
Laboratorio 2
1HJDWLYR
1HJDWLYR
Penicillium VSS
1RVHHQYLy
1HJDWLYR
Enterobacter cloacae
1HJDWLYR
1HJDWLYR
Klebsiella pneumoniae Raoultella planticolla Leclercia adenocarboxylata Pseudomonas putida
1HJDWLYR
'
1HJDWLYR
1HJDWLYR
adecarboxylate (Q YDULDV RFDVLRQHV SRVWHULRUHV VH LQWHQWy FDPELDU VX FODVLÀFDFLyQ KDVWD TXH ÀQDOPHQWH HQ 7DPXUD et al. EDVDGRV HQ HO HVWXGLR GH KLEULGDFLyQ GH $'1$'1 GH VX FROHFFLRQHVGHEDFWHULDV\HQODVFDUDFWHUtVWLFDV IHQRWtSLFDV SURSXVLHURQ XQ QXHYR JpQHUR OODPDGRLeclercia FRQXQDHVSHFLH adecarboxylata (8)./DPD\RUtDGHODVFHSDVVRQVHQVLEOHVDFROLVWLQD iFLGR QDOLGt[LFR VXOIDGLD]LQD JHQWDPLFLQD HVWUHSWRPLFLQD WHWUDFLFOLQD FORUDQIHQLFRO FDUEHQLFLOOLQDV FHIDORVSRULQDV \ DPSLFLOLQD SRU HOPpWRGRGHGLIXVLyQGHGLVFRHQHOPHGLRGH 0XHOOHU+LQWRQ \UHVLVWHQWHVDODSHQLFLOLQD (OSULPHUFDVRFOtQLFRUHSRUWDGRHQHOIndex Medicus 0HGOLQH3XE0HG VH GRFXPHQWy HQ (VSDxD HQ HQ XQ KRPEUH GH DxRV FRQ FLUURVLV DOFRKyOLFD D TXLHQ VH OH SUDFWLFy XQD SDUDFHQWHVLV HYDFXDQWH 6HLV KRUDV GHVSXpV SUHVHQWyGRORUDEGRPLQDOLQWHQVRKLSRWHQVLyQ WDTXLFDUGLD \ GLDIRUHVLV SRU OR TXH IXH OOHYDGR D ODSDURWRPtD FRQ GLDJQyVWLFR GH KHPRSHULWRQHR&XDWURGtDVGHVSXpVGHODFLUXJtDSUHVHQWy ÀHEUH KDVWD & \ HQ WUHV KHPRFXOWLYRV GH VDQJUHSHULIpULFDVHLGHQWLÀFyL. adecarboxylata. $ SHVDU GHO WUDWDPLHQWR DQWLELyWLFR LQVWDXUDGR HO SDFLHQWH GHVDUUROOy LQVXÀFLHQFLD UHQDO DJXGD \ IDOOHFLy D ORV GtDV GHO HSLVRGLR (Q HO se reportyHOSULPHUFDVRGHSHULWRQLWLVGHELGD D HVWH PLFURRUJDQLVPR HQ XQ QLxR GH DxRV TXHHVWDEDHQGLiOLVLVSHULWRQHDOFRQWLQXDGHVGH PHVHV DQWHV GHO HSLVRGLR /D HQIHUPHGDG VHGHVFULELyFRPRKRUDVGHGRORUDEGRPLQDO SURJUHVLYRÀHEUHGLDUUHDDFXRVD\YyPLWR(QHO
$62&,$&,Ï1&2/20%,$1$'(,1)(&72/2*Ë$
H[DPHQItVLFRVHHQFRQWUyÀHEUHWDTXLFDUGLDWDTXLSQHDGLVWHQVLyQDEGRPLQDOFRQGRORUGLIXVR GHIHQVDYROXQWDULD\DXVHQFLDGHUXLGRVLQWHVWLQDOHV(OOtTXLGRSHULWRQHDOWHQtDOHXFRFLWRVPP3\PHQRVGHXQHULWURFLWRODWLQFLyQGH *UDP QR HYLGHQFLy EDFWHULDV SHUR HQ HO FXOWLYR VHHQFRQWUyXQEDFLORJUDPHJDWLYRLGHQWLÀFDGR posteriormente como L. adecarboxylata(OQLxR UHFLELyWUDWDPLHQWRSDUHQWHUDO\DWUDYpVGHOFDWpWHUGHGLiOLVLVSHULWRQHDOFRQWLQXDFRQFHIWD]LGLPD\JHQWDPLFLQDGXUDQWHGtDV/RVFXOWLYRV SRVWHULRUHV IXHURQ QHJDWLYRV HO FDWpWHU GH OD GLiOLVLVQRVHUHWLUy\DQWHXQDHYROXFLyQFOtQLFD VDWLVIDFWRULDVHUHLQLFLyODGLiOLVLV (QHO'H%DHUHet al.,UHSRUWDURQGRVFDVRV GH LQIHFFLRQHV SRU HVWH JHUPHQ XQD SDFLHQWH GH DxRV FRQ SDQFUHDWLWLV ELOLDU \ FROHFLVWLWLV FUyQLFDHQODFXDOVHDLVOyODEDFWHULDGHODSLH]D TXLU~UJLFD\XQDSDFLHQWHGHDxRVTXHHQOD FXDUWDVHPDQDGHXQSRVWRSHUDWRULRGHFXDWUR SXHQWHVGHFRURQDULDVSUHVHQWyXQDEDFWHULHPLD SROLPLFURELDQDFRQDLVODPLHQWRGHEnterococcus faecalis, Escherichia hermannii y L. adecarboxylata (QHVWHPLVPRUHSRUWHVHGHVFULELyWDPELpQSRUSULPHUDYH]XQDQiOLVLVGHÀORJHQLDGH ODVFHSDVREWHQLGDVGHORVDLVODPLHQWRVFOtQLFRV 3RUPHGLRGHODGHWHUPLQDFLyQGHODVHFXHQFLD JHQpWLFDGHO$51ULERVyPLFR6GHDPEDVFHSDVGHL. adecarboxylataVHGHWHFWyXQDVLPLOLWXG GHO FRQPantoea agglomeransRWUREDFLOR JUDPQHJDWLYR GH OD IDPLOLD (QWHUREDFWHULDFHDH (11) (Q HO /HH et al, UHSRUWDURQ HO SULPHU FDVR FRQÀUPDGR SRU HFRFDUGLRJUDItD GRV KHPRFXOWLYRV \ HPEROLVPRV VpSWLFRV GH HQGRFDUGLWLV SRU L. adecarboxylata HQ XQD PXMHU GH DxRV FRQ FiQFHU HQGRPHWULDO (6) $XQTXH HO HVTXHPD ySWLPR GH WUDWDPLHQWR \ VX GXUDFLyQ QR HVWiQ GHÀQLGRV ORV DLVODPLHQWRV GH VDQJUH PRVWUDURQVHQVLELOLGDGDWRGRVORVDQWLPLFURELDQRV\ODSDFLHQWHIXHWUDWDGDH[LWRVDPHQWHFRQ DPSLFLOLQDVXOEDFWDP PiV JHQWDPLFLQD GXUDQWH VHPDQDVVLQQHFHVLGDGGHFLUXJtDYDOYXODU 3RURWUDSDUWHVHKDQUHSRUWDGRYDULRVEURWHVGH EDFWHULHPLDVDVRFLDGRVDOXVRGHKHSDULQDELHQ VHDHQVROXFLRQHVSUHSDUDGDVFRQVXHURVDOLQRR
,QIHFWLR
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina
HQMHULQJDVOOHQDGDVSUHYLDPHQWH 3URVSHUR et al., ORJUDURQLGHQWLÀFDUSRUPHGLRGHHOHFWURIRUHVLVHQJHOGHFDPSRSXOVDGR 3)*( ODPLVPD FORQDGHPseudomonas aeruginosa HQFXDWURSDFLHQWHVFRQEDFWHULHPLDDVRFLDGDDFDWpWHU\HQ XQD PXHVWUD WRPDGD GH OD PH]FOD GH VROXFLyQ VDOLQD \ KHSDULQD HPSOHDGD SDUD SHUPHDELOL]DU ORV FDWpWHUHV (18)7DPELpQ SRU PHGLR GH 3)*(
,QIHFWLR
Referencias
3pUH]0RUHQR02$QJXHUD-&DUXOOD03pUH]0RUHQR0$UWULWLV VpSWLFDSRULeclercia adecarboxylataGHRULJHQSUREDEOHPHQWH\DWURJpQLFR(QIHUP,QIHFF0LFURELRO&OLQ 'DYHQSRUW 3 /DQG .- ,VRODWLRQ RI Leclercia adecarboxylata from WKHEORRGFXOWXUHRIDQDV\PSWRPDWLFSODWHOHWGRQRU7UDQVIXVLRQ 'DODPDJD03DQWHODNL0.DUPDQLRODV.'DVNDORSRXORX.0LJGDOLV,,VRODWLRQRILeclercia adecarboxylataIURPEORRGDQGEXUQ ZRXQGDIWHUDK\GURÁXRULFDFLGFKHPLFDOLQMXU\%XUQV 6DUPD 30 %KDWWDFKDU\D ' .ULVKQDQ 6 /DO % 'HJUDGDWLRQ RI SRO\F\FOLF DURPDWLF K\GURFDUERQV E\ D QHZO\ GLVFRYHUHG HQWHULF EDFWHULXP Leclercia adecarboxylata. $SSO (QYLURQ 0LFURELRO )HUQiQGH]5XL] 0 /ySH]0HGUDQR ) *DUFtD6iQFKH] / *DUFtD 5H\QH $ 2UWXQR GH 6ROR 7 6DQ]6DQ] ) et al. 6XFFHVVIXO PDQDJHPHQW RI WXQQHOHG KHPRGLDO\VLV FDWKHWHUUHODWHG EDFWHUHPLD E\ Leclercia adecarboxylata ZLWKRXW FDWKHWHU UHPRYDO 5HSRUW RI WZR FDVHV,QW-,QIHFW'LV H /HH%6LU--3DUN6:.ZDN&+.LP60.LP6%et al. $FDVHRI Leclercia adecarboxylataHQGRFDUGLWLVLQDZRPDQZLWKHQGRPHWULDO FDQFHU$P-0HG6FL /HFOHUF+%LRFKHPLFDOVWXG\RISLJPHQWHG(QWHUREDFWHULDFHDH$QQ ,QVW3DVWHXU 3DULV 7DPXUD.6DND]DNL5.RVDNR<
COMUNICACIÓN BREVE
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina An outbreak of Leclercia adecarboxylata bacteremia likely associated to contaminated heparin vials $QD/XFtD&RUUHD/X]0DUtD0D]R0yQLFD3DWULFLD9DOGHUUDPD$OHMDQGUD5HVWUHSR)DELiQ-DLPHV
Resumen
Leclercia adecarboxylataHVXQDHQWHUREDFWHULiFHDUHSRUWDGDRFDVLRQDOPHQWHFRPRXQJHUPHQRSRUWXQLVWDTXHFRPSURPHWHSDFLHQWHVFRQDOJ~Q WLSRGHLQPXQRVXSUHVLyQFRPRQHXWURSHQLDFLUURVLVRFiQFHU6HUHSRUWDXQEURWHGHFLQFRFDVRVGHEDFWHULHPLDSRUL. adecarboxylata en pacientes FRQGLYHUVDVFRQGLFLRQHVGHLQPXQRVXSUHVLyQSUREDEOHPHQWHDVRFLDGRFRQHOXVRGHYLDOHVGHKHSDULQDFRQWDPLQDGRV6HKDFHXQDUHYLVLyQDFWXDOL]DGDGHODOLWHUDWXUD\XQDGLVFXVLyQVREUHORVDVSHFWRVSDUWLFXODUHVGHOEURWH\GHOPLFURRUJDQLVPR Palabras clave:KHSDULQDLeclercia adecarboxylataEDFWHULHPLDEURWH
Abstract
Leclercia adecarboxylata LVSDUWRIWKH(QWHUREDFWHULDFHDHIDPLO\RFFDVLRQDOO\UHSRUWHGDVDQRSSRUWXQLVWPLFURRUJDQLVPLQSDWLHQWVZLWKDQ\NLQG RILPPXQRVXSSUHVVLRQDVQHXWURSHQLDFLUUKRVLVRUFDQFHU:HUHSRUWDQRXWEUHDNZLWKÀYHFDVHVRI Leclercia adecarboxylata EDFWHUHPLDLQSDWLHQWV ZLWKVHYHUDOLPPXQHFRQGLWLRQVPRVWOLNHO\DVVRFLDWHGWRFRQWDPLQDWHGKHSDULQYLDOV:HDOVRSUHVHQWDQXSGDWHGOLWHUDWXUHUHYLHZDQGGLVFXVVLRQ UHJDUGLQJWKHSDUWLFXODUFKDUDFWHULVWLFVRIWKHRXWEUHDNDQGWKHPLFURRUJDQLVP Keywords:KHSDULQ L. adecarboxylataEDFWHUHPLDRXWEUHDN
Introducción Leclercia adecarboxylataHVXQDEDFWHULDGHODIDPLOLD(QWHUREDFWHULDFHDHHQFRQWUDGDHQODÁRUD JDVWURLQWHVWLQDOQRUPDOGHDQLPDOHV\KXPDQRV (1) 6HKDFXOWLYDGRWDPELpQGHODSLHOGHLQGLYLGXRVVDQRVHODJXDORVDOLPHQWRVODOHFKH\HQ GLYHUVDVIXHQWHVDPELHQWDOHVFRPRUHVHUYDVGH JUDVDV\DFHLWHVLQGXVWULDOHV (OPLFURRUJDQLVPRHVFRVPRSROLWDSHURVXYHUGDGHURVLJQLÀFDGRFOtQLFR\VXYLUXOHQFLDQRVRQ FODURVGDGRHOHVFDVRQ~PHURGHSXEOLFDFLRQHV UHODFLRQDGDV FRQ HVWH WHPD (Q OD PD\RUtD GH FDVRVLQIRUPDGRVVHSUHVHQWDFRPRXQJHUPHQ RSRUWXQLVWDTXHFRPSURPHWHSDFLHQWHVFRQDO &RPLWpGH3UHYHQFLyQGH,QIHFFLRQHV+RVSLWDO3DEOR7REyQ8ULEH 0HGHOOtQ&RORPELD *UXSRGH)DUPDFRYLJLODQFLD+RVSLWDO3DEOR7REyQ8ULEH 0HGHOOtQ&RORPELD 8QLGDGGH,QYHVWLJDFLRQHV+RVSLWDO3DEOR7REyQ8ULEH 'HSDUWDPHQWRGH0HGLFLQD,QWHUQD8QLYHUVLGDGGH$QWLRTXLD 0HGHOOtQ&RORPELD
,QIHFWLR
J~QWLSRGHLQPXQRVXSUHVLyQFRPRQHXWURSHQLDFLUURVLVRFiQFHU\VXHOHDLVODUVHGHLQIHFFLRQHVSROLPLFURELDQDV (QHVWHUHSRUWHVHGHVFULEHXQEURWHGHEDFWHriemias por L. adecarboxylata SUREDEOHPHQWH DVRFLDGRDOXVRGHKHSDULQDSUHPH]FODGDFRQWDPLQDGDXWLOL]DGDSDUDSHUPHDELOL]DUORVDFFHVRV YHQRVRV FHQWUDOHV \ SHULIpULFRV \ VH SUHVHQWD DGHPiVXQDUHYLVLyQDFWXDOL]DGDGHODOLWHUDWXUD
Métodos y resultados (O KRVSLWDO GRQGH VH SUHVHQWDURQ ORV FDVRV HV XQD LQVWLWXFLyQ XQLYHUVLWDULD GH WHUFHU QLYHO GH FRPSOHMLGDGFRQFDPDVGHODVFXDOHVVRQ 5HFLELGR $FHSWDGR &RUUHVSRQGHQFLD $QD/XFtD&RUUHD&RPLWpGH3UHYHQFLyQGH ,QIHFFLRQHV+RVSLWDO3DEOR7REyQ8ULEH&DOOH%1Ĉ 0HGHOOtQ&RORPELD7HOpIRQR H[WHQVLyQ &RUUHR HOHFWUyQLFR DFRUUHD#KSWXRUJFR
Correa AL, Mazo LM, Valderrama MP, et al
GHFXLGDGRVLQWHQVLYRV&XHQWDFRQWRGDVODVHVSHFLDOLGDGHV PpGLFRTXLU~UJLFDV H[FHSWR REVWHWULFLD\HVDGHPiVXQFHQWURGHWUDVSODQWHVGH PpGXODyVHDKtJDGRULxyQ\PXOWLYLVFHUDO 6HLGHQWLÀFyHOFDVRtQGLFHHQXQDPXMHUGH DxRV FRQ GLDJQyVWLFR GH OHLRPLRVDUFRPD GH ~WHURHVWDGR,9FRQPHWiVWDVLVUHWURSHULWRQHDO \HQSURJUHVLyQSXOPRQDUTXHFRQVXOWyDO6HUYLFLR GH 8UJHQFLDV OD QRFKH GHO GH DEULO GH SRUXQDVHPDQDGHHYROXFLyQGHÀHEUH\ HVFDORIUtR /D SDFLHQWH HVWDED HQ WUDWDPLHQWR FRQ TXLPLRWHUDSLD GHVGH HO GH IHEUHUR GHO PLVPR DxR IHFKD HQ OD TXH VH OH LPSODQWy XQ FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD\GtDV DQWHVGHODFRQVXOWDKDEtDUHFLELGRXQWHUFHUFLFORGHTXLPLRWHUDSLD (QODYDORUDFLyQLQLFLDOGHXUJHQFLDVQRVHGHWHFWyXQIRFRHYLGHQWHGHLQIHFFLyQ HOUHFXHQWRGH EODQFRVDOLQJUHVRHUDGHOHXFRFLWRVWRWDOHV FRQ GH SROLPRUIRQXFOHDUHV QHXWUyÀORV \ GHVSXpVGHPLQXWRVGHWRPDGRVORVKHPRFXOWLYRVDWUDYpVGHOFDWpWHUFHQWUDOGHLQVHUFLyQ SHULIpULFD VH GHWHFWy FUHFLPLHQWR GH XQ EDFLOR JUDPQHJDWLYR (O GH PD\R VH KL]R HO UHSRUWH GHÀQLWLYR GH FUHFLPLHQWR GH L. adecarboxylata \ QR VH REWXYR FUHFLPLHQWR GH JHUPHQ HQ ORV RWURVGRVFXOWLYRVWRPDGRVVLPXOWiQHDPHQWHGH VDQJUHSHULIpULFD'HVGHHOLQJUHVRSRUXUJHQFLDV VHLQLFLyWUDWDPLHQWRHPStULFRFRQSLSHUDFLOLQD WD]REDFWDP\HOFDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFDVHUHWLUyHOGHPD\R/DSDFLHQWHHVWXYR HVWDEOH GXUDQWH WRGD VX KRVSLWDOL]DFLyQ QR UHTXLULyPDQHMRHQFXLGDGRFUtWLFR\IXHGDGDGH DOWDHQEXHQDVFRQGLFLRQHVHOGHPD\R (OPLVPRGHPD\RHO/DERUDWRULRGH0LFURELRORJtD LQIRUPy FUHFLPLHQWR GH L. adecarboxylata HQ XQ KHPRFXOWLYR WRPDGR SRU FDWpWHU GH FiPDUD LPSODQWDEOH HQ XQ QLxR GH DxRV FRQ GLDJQyVWLFRGHOHXFHPLDOLQIRLGHDJXGD(OQLxR HVWDEDKRVSLWDOL]DGRGHVGHHOGHDEULOSRUUHFDtGD GH VX OHXFHPLD UHFLELHQGR TXLPLRWHUDSLD GH UHVFDWH \ \D KDEtD SUHVHQWDGR XQ HSLVRGLR GH QHXWURSHQLD IHEULO FRQ FXOWLYRV QHJDWLYRV \
$62&,$&,Ï1&2/20%,$1$'(,1)(&72/2*Ë$
WUDWDPLHQWRHPStULFRFRQFHIHSLPHHQWUHHO\ HOGHHVHPHV(OGHPD\RSUHVHQWyQXHYR HSLVRGLRGHQHXWURSHQLDIHEULOFRQOHXFRFLWRV WRWDOHV SRU OR TXH VH VROLFLWDURQ KHPRFXOWLYRV WRPDGRV D WUDYpV GHO FDWpWHU GH FiPDUD LPSODQWDEOH 1 \ GH VDQJUH SHULIpULFD 1 /XHJRGHPLQXWRVGHLQFXEDFLyQGHOKHPRFXOWLYR WRPDGR D WUDYpV GHO FDWpWHU VH REWXYR FUHFLPLHQWRGHPantoeaVSS\L. adecarboxylata. $OWUDWDPLHQWRLQLFLDGRHOGHPD\RFRQFHIHSLPH VH DJUHJy SRVWHULRUPHQWH FOLQGDPLFLQD \ DPLNDFLQD HO FDWpWHUGHFiPDUDLPSODQWDEOH VH UHWLUyHOGHPD\R\HOQLxRIXHGDGRGHDOWDHQ EXHQDVFRQGLFLRQHVHOGHPD\R $QWHHOKDOOD]JRHQXQPLVPRGtDHQPXHVWUDVGH KHPRFXOWLYRV GH GRV SDFLHQWHV GLIHUHQWHV GH XQ JHUPHQ QR FRQRFLGR SUHYLDPHQWH HQ OD LQVWLWXFLyQVHKL]RXQDUHYLVLyQH[KDXVWLYDGHWRGRVORV UHVXOWDGRV PLFURELROyJLFRV UHSRUWDGRV FRQ DQWHULRULGDG$QWHVGHOGHPD\RVyORVHHQFRQWUyXQ UHSRUWHGHOGHDEULOGHHVHDxRHQXQKHPRFXOWLYR SRVLWLYR SDUD L. adecarboxylata, WRPDGR SRUFDWpWHUGHFiPDUDLPSODQWDEOHHQXQDQLxDGH DxRVFRQGLDJQyVWLFRGHDQHPLDGH'LDPRQG %ODFNIDQ GHVGH ORV PHVHV GH HGDG KLSRSODVLD VHOHFWLYD GH JOyEXORV URMRV DGHPiV GH GLDEHWHV PHOOLWXV WLSR KLSHUWHQVLyQ SXOPRQDU \ VRUGHUD QHXURVHQVRULDO /D SDFLHQWH WHQtD HO FDWpWHU GH FiPDUDLPSODQWDEOHGHVGHHOGHGLFLHPEUHGH SRUODQHFHVLGDGGHWUDVIXVLRQHVDUHSHWLFLyQ \ OD PXHVWUD GHO GH DEULO WRPDGD SDUD HO KHPRFXOWLYR VH KL]R FRPR SDUWH GH XQ FRQWURO PLFURELROyJLFRSRUXQHSLVRGLRSUHYLRGHEDFWHULHPLD DVRFLDGD D FDWpWHU GDGR TXH SDUD HVD IHFKD QR VH UHIHUtDQ VtQWRPDV QL VLJQRV TXH VXJLULHVHQ LQIHFFLyQ&RQODHYROXFLyQFOtQLFDVDWLVIDFWRULDGH OD QLxD HO UHVXOWDGR IXH LQWHUSUHWDGR FRPR FRQWDPLQDFLyQ SRU OR TXH QR VH UHDOL]DURQ FDPELRV HQHOHVTXHPDDQWLELyWLFRLQLFLDGRDQWHULRUPHQWH SDUDJUDPSRVLWLYRV\ODSDFLHQWHIXHGDGDGHDOWD HQEXHQDVFRQGLFLRQHVHOGHDEULO3RVWHULRUDO GHPD\RVHGRFXPHQWDURQGRVFDVRVDGLFLRQDOHV HQ PXHVWUDV GH VDQJUH WRPDGDV HO GH PD\R \ HOGHPD\RWDPELpQHQSDFLHQWHVFRQGLYHUVDV FRQGLFLRQHVGHLQPXQRVXSUHVLyQ WDEOD
,QIHFWLR
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina Tabla 1. 3ULQFLSDOHVFDUDFWHUtVWLFDVGHORVFLQFRFDVRVGHEDFWHULHPLDSRULeclercia adecarboxylata Edad (años)
Sexo
Femenino
51
Femenino
5
0DVFXOLQR
74
Femenino
&LUURVLV\ KHSDWRFDUFLQRPD
65
0DVFXOLQR
&iQFHUGHFROyQHVWDGR ,9
Diagnóstico inicial
Síntomas previos
Tipo de muestra
&&,
3LSHUDFLOLQD WD]REDFWDP\ vancomicina
Vivo
3LSHUDFLOLQD WD]REDFWDP
Vivo
$QHPLDGH'LDPRQG %ODFNIDQ
1LQJXQR
/HLRPLRVDUFRPDGH ~WHURHVWDGR,9
)LHEUH HVFDORIUtRV
3,&&
/HXFHPLDOLQIRLGHDJXGD
)LHEUH HVFDORIUtRV WHPEORU
&&,
0DOHVWDU JHQHUDO DGLQDPLD
Vena SHULIpULFD
)LHEUH HVFDORIUtRV VXGRUDFLyQ
3,&&
Tratamiento antibiótico
Estado vital al alta
Recuento de leucocitos
&HIHSLPH Vivo $PSLFLOLQD VXOEDFWDP
0XHUWR
1LQJXQR 0XHUWR
&&, FDWpWHUGHFiPDUDLPSODQWDEOH 3,&& FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD
$SDUWLUGHORVGRVFDVRVDGLFLRQDOHVLGHQWLÀFDGRV\HYDOXDGRVVHLQWHUURJyGHQXHYRDODSDFLHQWHGHOFDVRtQGLFHVREUHVXHQIHUPHGDGDFWXDO/DSDFLHQWHUHODFLRQDEDFODUDPHQWHODDSDULFLyQGHORVHSLVRGLRVGHÀHEUH\HVFDORIUtRFRQ ODDSOLFDFLyQGHORVERORVGHKHSDULQDLQGLFDGRV DPEXODWRULDPHQWHSDUDPDQWHQHUSHUPHDEOHHO FDWpWHUFHQWUDOGHLQVHUFLyQSHULIpULFD (QHOSHULRGRFRUUHVSRQGLHQWHDOEURWHHVWDEDQ FLUFXODQGRHQODLQVWLWXFLyQFLQFRORWHVGLIHUHQWHV GHYLDOHVGHKHSDULQDSUHPH]FODGDGHODPDUFD $\XQORWHGHODPDUFD%7RGRVORVORWHVVHUHWLUDURQGHORVGLIHUHQWHVVHUYLFLRVGHOKRVSLWDO\ GHODIDUPDFLD\VHHQYLDURQGLIHUHQWHVPXHVWUDV SDUD FXOWLYR DO ODERUDWRULR GH OD LQVWLWXFLyQ \ D XQODERUDWRULRLQGHSHQGLHQWH&DGDODERUDWRULR UHFLELySDUDORVDQiOLVLVGLIHUHQWHVYLDOHVDXQTXH FRUUHVSRQGLHQWHVDOPLVPRORWH/RVUHVXOWDGRV HYLGHQFLDURQ FUHFLPLHQWR GH GLYHUVRV PLFURRUJDQLVPRVHQWUHHOORVL. adecarboxylataHQDOJXQDVGHODVPXHVWUDVUHFROHFWDGDV WDEOD (OSURFHGLPLHQWRDFWXDOGHOKRVSLWDOQRSHUPLWH HO UHJLVWUR \ HO VHJXLPLHQWR LQGLYLGXDO GH FDGD XQLGDG GH PHGLFDPHQWR GHVGH TXH LQJUHVD D ODIDUPDFLDKDVWDVXGLVSRVLFLyQÀQDO\DVHDXQ SDFLHQWHGHWHUPLQDGRGHYROXFLyQDODIDUPDFLD RGHVHFKRUD]yQSRUODTXHHVLPSRVLEOHGHWHUPLQDUTXpORWHVHDSOLFyDFDGDSDFLHQWH/RTXH
,QIHFWLR
VtHVFODURHVTXHWRGRVORVSDFLHQWHVFRQDFFHVR YHQRVRSHULIpULFRRFHQWUDOHVWXYLHURQHQULHVJRGHHVWDUH[SXHVWRVDORVYLDOHVFRQWDPLQDGRV $GHPiVQRVHDOPDFHQDURQODVFHSDVGHL. adecarboxylata TXH VH REWXYLHURQ GH ODV PXHVWUDV GHVDQJUHGHORVSDFLHQWHVSRUORTXHQRHVSRVLEOHGHWHUPLQDUODHSLGHPLRORJtDPROHFXODUGH GLFKDV FHSDV QL VX SRWHQFLDO FRQFRUGDQFLD FRQ ODVFHSDVREWHQLGDVGHODVPXHVWUDVGHKHSDULQD3RUORDQWHULRU\DSHVDUGHQRKDEHUWHQLGR QXHYRVHSLVRGLRVGHEDFWHULHPLDSRUL. adecarboxylata GHVSXpV GH PHVHV GH UHWLUDU WRGRV ORVORWHVGHKHSDULQDQRSRGHPRVHVWLPDUFRQ H[DFWLWXG \ SUHFLVLyQ XQD UHODFLyQ FDXVDO HQWUH ODKHSDULQD\ORVHSLVRGLRVLQIHFFLRVRVGHVFULWRV Revisión de la literatura y discusión Leclercia adecarboxylata HV XQ EDFLOR SHTXHxR TXH FUHFH ELHQ HQ ORV PHGLRV XVDGRV SDUD OD EDFWHULRORJtD GH ORV EDFLORV HQWpULFRV /OHYD VX QRPEUH HQ KRQRU D + /HFOHUF EDFWHULyORJR IUDQFpV TXLHQ HQ UHFRQRFLy XQD EDFWHULD TXHGHVFULELyFRPR´EDFWHULDFROLIRUPHSLJPHQWDGDGHDPDULOORµTXHHUDVLPLODUDE. coliHQODV UHDFFLRQHV,09L&SHURGLIHUtDSRUODSURGXFFLyQ GHXQSLJPHQWRDPDULOOR\VXFDSDFLGDGGHIHUPHQWDU YDULRV D]~FDUHV (7) ,QLFLDOPHQWH /HFOHUF SURSXVR TXH VH UHFRQRFLHUD FRPR XQD HVSHFLH DSDUWH GHQWUR GHO JpQHUR Escherichia como E.
Correa AL, Mazo LM, Valderrama MP, et al Tabla 2.5HVXOWDGRVGHORVHVWXGLRVPLFURELROyJLFRVHQODVPXHVWUDV GHKHSDULQD /RWHPXHVWUD
Laboratorio 1
Laboratorio 2
1HJDWLYR
1HJDWLYR
Penicillium VSS
1RVHHQYLy
1HJDWLYR
Enterobacter cloacae
1HJDWLYR
1HJDWLYR
Klebsiella pneumoniae Raoultella planticolla Leclercia adenocarboxylata Pseudomonas putida
1HJDWLYR
'
1HJDWLYR
1HJDWLYR
adecarboxylate (Q YDULDV RFDVLRQHV SRVWHULRUHV VH LQWHQWy FDPELDU VX FODVLÀFDFLyQ KDVWD TXH ÀQDOPHQWH HQ 7DPXUD et al. EDVDGRV HQ HO HVWXGLR GH KLEULGDFLyQ GH $'1$'1 GH VX FROHFFLRQHVGHEDFWHULDV\HQODVFDUDFWHUtVWLFDV IHQRWtSLFDV SURSXVLHURQ XQ QXHYR JpQHUR OODPDGRLeclercia FRQXQDHVSHFLH adecarboxylata (8)./DPD\RUtDGHODVFHSDVVRQVHQVLEOHVDFROLVWLQD iFLGR QDOLGt[LFR VXOIDGLD]LQD JHQWDPLFLQD HVWUHSWRPLFLQD WHWUDFLFOLQD FORUDQIHQLFRO FDUEHQLFLOOLQDV FHIDORVSRULQDV \ DPSLFLOLQD SRU HOPpWRGRGHGLIXVLyQGHGLVFRHQHOPHGLRGH 0XHOOHU+LQWRQ \UHVLVWHQWHVDODSHQLFLOLQD (OSULPHUFDVRFOtQLFRUHSRUWDGRHQHOIndex Medicus 0HGOLQH3XE0HG VH GRFXPHQWy HQ (VSDxD HQ HQ XQ KRPEUH GH DxRV FRQ FLUURVLV DOFRKyOLFD D TXLHQ VH OH SUDFWLFy XQD SDUDFHQWHVLV HYDFXDQWH 6HLV KRUDV GHVSXpV SUHVHQWyGRORUDEGRPLQDOLQWHQVRKLSRWHQVLyQ WDTXLFDUGLD \ GLDIRUHVLV SRU OR TXH IXH OOHYDGR D ODSDURWRPtD FRQ GLDJQyVWLFR GH KHPRSHULWRQHR&XDWURGtDVGHVSXpVGHODFLUXJtDSUHVHQWy ÀHEUH KDVWD & \ HQ WUHV KHPRFXOWLYRV GH VDQJUHSHULIpULFDVHLGHQWLÀFyL. adecarboxylata. $ SHVDU GHO WUDWDPLHQWR DQWLELyWLFR LQVWDXUDGR HO SDFLHQWH GHVDUUROOy LQVXÀFLHQFLD UHQDO DJXGD \ IDOOHFLy D ORV GtDV GHO HSLVRGLR (Q HO se reportyHOSULPHUFDVRGHSHULWRQLWLVGHELGD D HVWH PLFURRUJDQLVPR HQ XQ QLxR GH DxRV TXHHVWDEDHQGLiOLVLVSHULWRQHDOFRQWLQXDGHVGH PHVHV DQWHV GHO HSLVRGLR /D HQIHUPHGDG VHGHVFULELyFRPRKRUDVGHGRORUDEGRPLQDO SURJUHVLYRÀHEUHGLDUUHDDFXRVD\YyPLWR(QHO
$62&,$&,Ï1&2/20%,$1$'(,1)(&72/2*Ë$
H[DPHQItVLFRVHHQFRQWUyÀHEUHWDTXLFDUGLDWDTXLSQHDGLVWHQVLyQDEGRPLQDOFRQGRORUGLIXVR GHIHQVDYROXQWDULD\DXVHQFLDGHUXLGRVLQWHVWLQDOHV(OOtTXLGRSHULWRQHDOWHQtDOHXFRFLWRVPP3\PHQRVGHXQHULWURFLWRODWLQFLyQGH *UDP QR HYLGHQFLy EDFWHULDV SHUR HQ HO FXOWLYR VHHQFRQWUyXQEDFLORJUDPHJDWLYRLGHQWLÀFDGR posteriormente como L. adecarboxylata(OQLxR UHFLELyWUDWDPLHQWRSDUHQWHUDO\DWUDYpVGHOFDWpWHUGHGLiOLVLVSHULWRQHDOFRQWLQXDFRQFHIWD]LGLPD\JHQWDPLFLQDGXUDQWHGtDV/RVFXOWLYRV SRVWHULRUHV IXHURQ QHJDWLYRV HO FDWpWHU GH OD GLiOLVLVQRVHUHWLUy\DQWHXQDHYROXFLyQFOtQLFD VDWLVIDFWRULDVHUHLQLFLyODGLiOLVLV (QHO'H%DHUHet al.,UHSRUWDURQGRVFDVRV GH LQIHFFLRQHV SRU HVWH JHUPHQ XQD SDFLHQWH GH DxRV FRQ SDQFUHDWLWLV ELOLDU \ FROHFLVWLWLV FUyQLFDHQODFXDOVHDLVOyODEDFWHULDGHODSLH]D TXLU~UJLFD\XQDSDFLHQWHGHDxRVTXHHQOD FXDUWDVHPDQDGHXQSRVWRSHUDWRULRGHFXDWUR SXHQWHVGHFRURQDULDVSUHVHQWyXQDEDFWHULHPLD SROLPLFURELDQDFRQDLVODPLHQWRGHEnterococcus faecalis, Escherichia hermannii y L. adecarboxylata (QHVWHPLVPRUHSRUWHVHGHVFULELyWDPELpQSRUSULPHUDYH]XQDQiOLVLVGHÀORJHQLDGH ODVFHSDVREWHQLGDVGHORVDLVODPLHQWRVFOtQLFRV 3RUPHGLRGHODGHWHUPLQDFLyQGHODVHFXHQFLD JHQpWLFDGHO$51ULERVyPLFR6GHDPEDVFHSDVGHL. adecarboxylataVHGHWHFWyXQDVLPLOLWXG GHO FRQPantoea agglomeransRWUREDFLOR JUDPQHJDWLYR GH OD IDPLOLD (QWHUREDFWHULDFHDH (11) (Q HO /HH et al, UHSRUWDURQ HO SULPHU FDVR FRQÀUPDGR SRU HFRFDUGLRJUDItD GRV KHPRFXOWLYRV \ HPEROLVPRV VpSWLFRV GH HQGRFDUGLWLV SRU L. adecarboxylata HQ XQD PXMHU GH DxRV FRQ FiQFHU HQGRPHWULDO (6) $XQTXH HO HVTXHPD ySWLPR GH WUDWDPLHQWR \ VX GXUDFLyQ QR HVWiQ GHÀQLGRV ORV DLVODPLHQWRV GH VDQJUH PRVWUDURQVHQVLELOLGDGDWRGRVORVDQWLPLFURELDQRV\ODSDFLHQWHIXHWUDWDGDH[LWRVDPHQWHFRQ DPSLFLOLQDVXOEDFWDP PiV JHQWDPLFLQD GXUDQWH VHPDQDVVLQQHFHVLGDGGHFLUXJtDYDOYXODU 3RURWUDSDUWHVHKDQUHSRUWDGRYDULRVEURWHVGH EDFWHULHPLDVDVRFLDGRVDOXVRGHKHSDULQDELHQ VHDHQVROXFLRQHVSUHSDUDGDVFRQVXHURVDOLQRR
,QIHFWLR
Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina
HQMHULQJDVOOHQDGDVSUHYLDPHQWH 3URVSHUR et al., ORJUDURQLGHQWLÀFDUSRUPHGLRGHHOHFWURIRUHVLVHQJHOGHFDPSRSXOVDGR 3)*( ODPLVPD FORQDGHPseudomonas aeruginosa HQFXDWURSDFLHQWHVFRQEDFWHULHPLDDVRFLDGDDFDWpWHU\HQ XQD PXHVWUD WRPDGD GH OD PH]FOD GH VROXFLyQ VDOLQD \ KHSDULQD HPSOHDGD SDUD SHUPHDELOL]DU ORV FDWpWHUHV (18)7DPELpQ SRU PHGLR GH 3)*(
,QIHFWLR
Referencias
3pUH]0RUHQR02$QJXHUD-&DUXOOD03pUH]0RUHQR0$UWULWLV VpSWLFDSRULeclercia adecarboxylataGHRULJHQSUREDEOHPHQWH\DWURJpQLFR(QIHUP,QIHFF0LFURELRO&OLQ 'DYHQSRUW 3 /DQG .- ,VRODWLRQ RI Leclercia adecarboxylata from WKHEORRGFXOWXUHRIDQDV\PSWRPDWLFSODWHOHWGRQRU7UDQVIXVLRQ 'DODPDJD03DQWHODNL0.DUPDQLRODV.'DVNDORSRXORX.0LJGDOLV,,VRODWLRQRILeclercia adecarboxylataIURPEORRGDQGEXUQ ZRXQGDIWHUDK\GURÁXRULFDFLGFKHPLFDOLQMXU\%XUQV 6DUPD 30 %KDWWDFKDU\D ' .ULVKQDQ 6 /DO % 'HJUDGDWLRQ RI SRO\F\FOLF DURPDWLF K\GURFDUERQV E\ D QHZO\ GLVFRYHUHG HQWHULF EDFWHULXP Leclercia adecarboxylata. $SSO (QYLURQ 0LFURELRO )HUQiQGH]5XL] 0 /ySH]0HGUDQR ) *DUFtD6iQFKH] / *DUFtD 5H\QH $ 2UWXQR GH 6ROR 7 6DQ]6DQ] ) et al. 6XFFHVVIXO PDQDJHPHQW RI WXQQHOHG KHPRGLDO\VLV FDWKHWHUUHODWHG EDFWHUHPLD E\ Leclercia adecarboxylata ZLWKRXW FDWKHWHU UHPRYDO 5HSRUW RI WZR FDVHV,QW-,QIHFW'LV H /HH%6LU--3DUN6:.ZDN&+.LP60.LP6%et al. $FDVHRI Leclercia adecarboxylataHQGRFDUGLWLVLQDZRPDQZLWKHQGRPHWULDO FDQFHU$P-0HG6FL /HFOHUF+%LRFKHPLFDOVWXG\RISLJPHQWHG(QWHUREDFWHULDFHDH$QQ ,QVW3DVWHXU 3DULV 7DPXUD.6DND]DNL5.RVDNR<