Vol. 12. Núm. 50.
Páginas 2931-2940 (Marzo 2018)

Actualización
Infecciones por bacilos Gram negativos no fermentadores: Pseudomonas aeruginosa, Acinetobacter spp. y Stenotrophomonas maltophilia

Nonfermenting gram-negative infections: Pseudomonas aeruginosa, Acinetobacter spp. and Stenotrophomonas maltophilia

M. Íñigo PestañaaJ.L. del Pozob
Doi : https://10.1016/j.med.2018.02.010
Opciones
Resumen
Introducción

Los bacilos Gram negativos no fermentadores constituyen un complejo conjunto de microorganismos aerobios estrictos, de distribución universal, con gran resistencia a factores ambientales severos, lo que les permite propagarse rápidamente y desarrollar resistencia a todos los antimicrobianos convencionales.

 Factores de riesgo

Dentro de estos, Pseudomonas aeruginosa, Acinetobacter baumanii y Stenotrophomonas maltophilia son los que tienen mayor implicación clínica. Se consideran microorganismos oportunistas, ya que afectan principalmente a pacientes hospitalizados en unidades de críticos, inmunodeprimidos, portadores de material protésico, ampliamente instrumentados y tratados previamente con antibióticos. También se caracterizan por causar brotes en los hospitales.

 Manifestaciones clínicas

Destacan como patógenos del tracto respiratorio inferior, siendo la principal causa de neumonía asociada a ventilación mecánica e infección respiratoria en pacientes con fibrosis quística.

 Tratamiento

El tratamiento de las infecciones causadas por estos microorganismos es complicado, ya que no sólo presentan resistencia natural a diferentes familias de antibióticos sino que además tienen una gran capacidad para adquirir nuevos mecanismos de resistencia durante el tratamiento, por lo que a menudo presentan patrones de multirresistencia.

Palabras clave
Pseudomonas
Acinetobacter
Stenotrophomonas
Infección
Abstract
Introduction

The nonfermenting gram-negative bacilli are a complex set of strictly aerobic microorganisms, universally distributed, and highly resistant to severe environmental factors, which enables them to propagate rapidly and develop resistance to all the conventional antimicrobials.

 Risk Factors

Pseudomonas aeruginosa, Acinetobacter baumanii and Stenotrophomonas maltophilia have major clinical implications. These are considered to be opportunist microorganisms, since they principally affect hospitalised patients in critical care units, who are immunosuppressed, users of prosthetic material, with multiple catheters and treated previously with antibiotics. The bacilli also typically cause outbreaks in hospitals.

 Clinical manifestations

They are major pathogens of the lower respiratory tract, and the main causative agents of mechanical ventilator-related pneumonia in patients with cystic fibrosis.

 Treatment

The infections caused by the microorganisms are difficult to treat, not only because of their natural resistance to different antibiotic families, they also have a great capacity to acquire new resistance mechanisms during treatment, and therefore often have multiresistance patterns.

Keywords
Pseudomonas
Acinetobacter
Stenotrophomonas
Infection

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