ABSTRACT Enterobacteria-producing extended-spectrum β-lactamases (ESBL) play an important role in healthcare infections, increasing hospitalization time, morbidity and mortality rates. Among several ESBLs that emerge from these pathogens, CTX-M-type enzymes had the most successful global spread in different epidemiological settings. Latin America presents high prevalence of CTX-M-2 in ESBL-producing enterobacterial infections with local emergence of the CTX-M-1 group. However, this high prevalence of the CTX-M-1 group has not yet been reported in Chile. The aim of this study was to identify ESBLs among enterobacteria isolated from clinical samples of critically ill patients from southern Chile. One-hundred thirty seven ESBL-producing bacteria were isolated from outpatients from all critical patient units from Hernán Henríquez Aravena Hospital. Phenotype characterization was performed by antibiogram, screening of ESBL, and determination of minimum inhibitory concentration (MIC). PCR was used for genetic confirmation of resistance. Molecular typing was performed by ERIC-PCR. ESBL-producing isolates were identified as Klebsiella pneumoniae (n = 115), Escherichia coli (n = 18), Proteus mirabilis (n = 3), and Enterobacter cloacae (n = 1), presenting multidrug resistance profiles. PCR amplification showed that the strains were positive for blaSHV (n = 111/81%), blaCTX-M-1 (n = 116/84.7%), blaTEM (n = 100/73%), blaCTX-M-2 (n = 28/20.4%), blaCTX-M-9 (0.7%), blaPER-1 (0.7%), and blaGES-10 (0.7%). The multiple production of ESBL was observed in 93% of isolates, suggesting high genetic mobility independent of the clonal relationship. The high frequency of the CTX-M-1 group and a high rate of ESBL co-production are changing the epidemiology of the ESBL profile in Chilean intensive care units. This epidemiology is a constant and increasing challenge, not only in Chile, but worldwide.

Background: The association between ethnicity and HIV/AIDS is an emerging and unexplored issue in Chile. Aim: To determine the profile of patients with HIV/AIDS by ethnicity and socioeconomic factors associated with diagnostic-therapeutic opportunity in the Araucania and Metropolitan regions. Methods: Cross-sectional study with 558 patients from two centers of HIV/AIDS in Chile. Data were collected using a questionnaire with clinical and sociocultural data obtained under informed consent. Descriptive analysis raw and stratified associations for each variable was performed. Results: Mapuche patients were mostly male, heterosexual (53.1%), lower average age (36.7 years), educational and income level lower than no Mapuche patients. The median of CD4(+) lymphocytes from Mapuche patients was the lowest in the sample, less than 51 cells/mm3, under 25 percentile (CI 38-123). Lifestyle variables indicated that drug use, number of sexual partners, and relationships between men were associated with higher levels of income, education and no Mapuche ethnicity. Conclusion: There are differences between Mapuche and non Mapuche patients regarding their sociocultural and clinical status, which generates health inequalities.

Resumen Introducción: La asociación entre etnicidad e infección por VIH/SIDA constituye un tema emergente y poco explorado en Chile. Objetivo: Describir el perfil de pacientes con infección por VIH/SIDA según etnia Mapuche y no Mapuche asociados a condiciones clínicas, factores socio-económicos y oportunidad terapéutica en pacientes de dos centros de atención de las regiones Araucanía y Metropolitana, Chile. Material y Método: Estudio de corte transversal con 558 pacientes cuyos datos se recolectaron mediante un formulario que contenía las variables del estudio, obtenidos tras consentimiento informado. Se realizó análisis descriptivo, asociaciones crudas y estratificadas por cada variable. Resultados: Los pacientes Mapuche fueron en su mayoría de sexo masculino, 53,1% heterosexuales, edad promedio 36,7 años, y nivel educacional e ingresos más bajos que los no Mapuche. La mediana de LT CD4 basal fue más baja en pacientes Mapuche, 51 céls/mm3 o menos y bajo el percentil 25 (IC 38-123). Se observó que existe mayor consumo de drogas, comercio sexual, sexo entre hombres y mayor número de parejas sexuales en último mes, en personas de la etnia no Mapuche y que, además, tienen mejores niveles de ingreso y educación. Conclusión: Existen perfiles diferenciados según etnia respecto de la condición sociocultural y de ingreso de los pacientes a control, generando inequidad en un tratamiento oportuno hacia los pacientes Mapuche, de baja escolaridad y menor educación.

Introduction: Streptococcus agalactiae (GBS) is the most common agent in early neonatal sepsis. Strategies incorporating universal screening for maternal colonization show the lowest rates of perinatal infection. A significant increase in resistance to erythromycin and clindamycin by GBS has been reported around the world. There are no published data regarding prevalence and antimicrobial resistance in southern regions of Chile. Surveillance of antimicrobial resistance is essential to define the drugs of choice and alternatives, in an institution that applies prevention protocols, as Clinica Alemana Temuco (CAT) does. Objectives: to determine the prevalence of carriage of GBS in vaginal-anal areas at end of pregnancy, in CAT, Araucanía Region, Chile. To determine the susceptibility to erythromycin and clindamycin of GBS strains isolated. Results: 1,181 pregnant women were included; 167 were positive for GBS (14.4% of colonization). Sixteen were resistant to erythromycin (9.5%); 15 of these strains were also clindamycin resistant. Twenty-three of 167 were resistant to clindamycin (13.7%). Conclusions: The prevalence rate of GBS colonization was lower than previously reported in other regions of Chile. Due to the high rates of resistance to clindamycin and erythromycin it is necessary to widen the study of susceptibility to other antimicrobials to have alternatives in allergy to penicillin (primarily cefazolin and vancomycin).

Introducción: Streptococcus agalactiae es el más frecuente causal de sepsis neonatal precoz. Las estrategias con pesquisa universal de colonización materna muestran las tasas más bajas de infección perinatal. Se ha reportado un significativo aumento de resistencia de S. agalactiae a eritromicina y clindamicina en el mundo. No existen datos publicados de prevalencia y susceptibilidad antimicrobiana en las regiones del sur de Chile. La vigilancia de resistencia es fundamental para definir los antimicrobianos de elección y alternativas para prevención del cuadro en instituciones que apliquen estrategias de prevención, como Clínica Alemana Temuco (CAT). Objetivos: Determinar la prevalencia de portación de S. agalactiae en la región vaginal-anal de mujeres embarazadas de tercer trimestre en CAT. Determinar la susceptibilidad a eritromicina y clindamicina de las cepas aisladas. Resultados: 1.181 embarazadas fueron incluidas. 167 resultaron S. agalactiae (+) (14,4% de colonización). Diez y seis eran resistentes a eritromicina (9,5%). Quince de ellas también lo eran a clindamicina. Veintitrés de 167, eran resistentes a clindamicina (13,7%). Conclusiones: La tasa de prevalencia de colonización (14%) fue más baja que lo reportado anteriormente en el centro del país. Debido a la alta tasa de resistencia a clindamicina y eritromicina se hace necesario aumentar el estudio de susceptibilidad a otros antimicrobianos alternativos en pacientes alérgicas a penicilina (principalmente cefazolina y vancomicina).