taller

antibiogra
ma
Paula María Puerto López
Interna Unisanitas
Contenido
01 02
MARKET
03
GOALS &
definición
ANALYSIS STRATEGY
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topic of the section here of the section here of the section here

04
CONTENT
05 06
KPI
BUDGET
PLAN
You could describe the You could describe the OVERVIEW
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 Lectura
epidemiolog
interpreta fenotipo
De los mecanismos
ía
Datos de importancia

da
de resistencia epidemiológica

Cantón R. Lectura interpretada del antibiograma: una necesidad clínica [Interpretive reading of the antibiogram: a clinical necessity]. Enferm Infecc Microbiol Clin. 2010 Jun-Jul;28(6):375-85.
Spanish. doi: 10.1016/j.eimc.2010.01.001. Epub 2010 Apr 9. Erratum in: Enferm Infecc Microbiol Clin. 2011 Mar;29(3):244. PMID: 20381926.
 Sensible
M/O inhibido. Alta probabilidad de éxito
terapéutico.

definicion intermedio
Efecto terapéutico incierto

es resistente
Alta probabilidad de fracaso terapéutico

Cantón R. Lectura interpretada del antibiograma: una necesidad clínica [Interpretive reading of the antibiogram: a clinical necessity]. Enferm Infecc Microbiol Clin. 2010 Jun-Jul;28(6):375-85.
Spanish. doi: 10.1016/j.eimc.2010.01.001. Epub 2010 Apr 9. Erratum in: Enferm Infecc Microbiol Clin. 2011 Mar;29(3):244. PMID: 20381926.
 Mecanismos de resistencia
● Modificaciones de la diana antimicrobiana: disminución de la
afinidad por el fármaco
● Disminución de la captación del fármaco,
● Activación de mecanismos de eflujo para extruir la molécula
nociva

genética
● Cambios globales en vías metabólicas importantes a través de
la modulación de redes reguladoras.

Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016 Apr;4(2):10.1128/microbiolspec.VMBF-0016-2015. doi: 10.1128/microbiolspec.VMBF-0016-2015. PMID:
27227291; PMCID: PMC4888801.
 Mecanismos de resistencia
● Modificaciones de la molécula antimicrobiana,
● Prevención para alcanzar la diana antibiótica (disminuyendo la
penetración o extruyendo activamente el compuesto
antimicrobiano)
● Cambios y/o derivación de los sitios diana

mecánic
● Resistencia debida a procesos adaptativos celulares globales.

Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016 Apr;4(2):10.1128/microbiolspec.VMBF-0016-2015. doi: 10.1128/microbiolspec.VMBF-0016-2015. PMID:
27227291; PMCID: PMC4888801.
Muestras
ORINA RESPIRATORIO
SANGRE OTRAS
 Mecanismos de resistencia
Betalactámicos B-lactamasas: hidrólisis de compuestos químicos que contienen un anillo
B-lactámico

Aminoglucósidos Inactivación enzimática: AAC, APH, ANT. Metiltransferasa: ArmA, Rmt,

Nmp

Glucopéptidos Modificación de la molécula con disminución de la afinidad para la unión

Fluoroquinolonas Mutaciones en gen de la ADN girasa y topoisomerasa IV: afectan porinas

y el LPS

TMP - SMX Mutación dihidropeptorato sintetasa

Macrólidos / clindamicina Alteración subunidad 23s

Tetraciclinas Bombas de expulsión

Wachino JI, Doi Y, Arakawa Y. Aminoglycoside Resistance: Updates with a Focus on Acquired 16S Ribosomal RNA Methyltransferases. Infect Dis Clin North
Am. 2020 Dec;34(4):887-902. doi: 10.1016/j.idc.2020.06.002. Epub 2020 Sep 30. PMID: 33011054.
Cocos
gram +
 Staphylococcus aureus
Perfil de Mecanismo
resistencia

MRSA Gen mecA / mecC

PBP2a: baja afinidad por la mayoría de betalactámicos y puede reemplazar la función
de la biosíntesis de peptidoglicano en presencia de estos antibióticos.

BORSA Hiperproducción de betalactamasas

Borderline resistance: no se consideran sensibles o resistentes a meticilina

VISA Gen vanA

Hidrólisis de precursores del peptidoglicano dipéptidos D-Ala-D-Ala, que se
unen a la vancomicina,
Síntesis de precursores del peptidoglicano D-Ala-D-lactato, que no pueden
unirse a la vancomicina
Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, Harbarth S. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers. 2018 May 31;4:18033. doi:
10.1038/nrdp.2018.33. PMID: 29849094.
Factores de riesgo
a. Uso previo de antibióticos (cefalosporinas y
quinolonas)

b. VIH

c. Uso de drogas iv

d. Hemodiálisis

e. UCI o paciente multi-invadido

 S. Aureus

S Oxacilina
R

Patrón común Cefoxitin

- +

BORSA MRSA
Oxacilina
Cefalosporina 1º gen.
MIC <2 MIC >2
Aminopenicilina + Vancomicina
inhibidor
I R

VISA VRSA

Daptomicina + gentamicina/
rifampicina/ linezolid/ TMP-SMX /
McGuinness WA, Malachowa N, DeLeo FR. Vancomycin Resistance in Staphylococcus aureus. Yale J Biol Med. betalactámico
2017 Jun 23;90(2):269-281. PMID: 28656013; PMCID: PMC5482303.
 Abordaje
Silvestre Penicilinas

MSSA Penicilinas antiestreptocócicas (oxacilina) o C1ºgen (cefalexina,

cefazolina)

MRSA o BORSA Vancomicina, daptomicina, linezolid, ceftarolina,

clindamicina, TMP/SMX

VISA/GISA Daptomicina, linezolid, ceftarolina, clindamicina, TMP/SMX (en

combinación)

Lee, A., de Lencastre, H., Garau, J. et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers 4, 18033 (2018). https://doi.org/10.1038/nrdp.2018.33
Claves para el abordaje
MRSA
Vancomicina Primera línea

Daptomicina Primera línea, EVITAR en pulmón

Linezolid Primera línea, EVITAR en bacteremia

Ceftarolina Opción en VRSA

TMP SMX, clindamicina, Oral, opción en infecciones leves

doxiciclina
Bacilos
gram -
 Enterobacterias
Escherichia Coli- Shigella - Salmonella - Proteus - Klebsiella - Citrobacter - Serratia -
Enterobacter - Providencia - Morganella - Yersinia

Mecanismos de resistencia característicos:

● Blee
● AMPC
● KPC
● IRT

Navarro F, Miró E, Mirelis B. Lectura interpretada del antibiograma de enterobacterias [Interpretive reading of enterobacteria antibiograms]. Enferm Infecc Microbiol Clin. 2010 Nov;28(9):638-
45. Spanish. doi: 10.1016/j.eimc.2010.05.002. Epub 2010 Jul 1. PMID: 20579780.
 Navarro F, Miró E, Mirelis B. Lectura interpretada del antibiograma de enterobacterias [Interpretive reading of enterobacteria antibiograms]. Enferm Infecc Microbiol Clin. 2010 Nov;28(9):638-45. Spanish. doi:
10.1016/j.eimc.2010.05.002. Epub 2010 Jul 1. PMID: 20579780.

Resistencias naturales
GRUPO 1 GRUPO 2 GRUPO 3 GRUPO 4

Bacterias Escherichia*, Shigella*, Klebsiella, Serratia, Yersinia enterocolitica

Salmonela y P. citrobacter enterobacter,
mirabilis koseri y Providencia,
amalonaticus morganella

S Betalactámicos Cefalosporinas, Carboxi/

monobactámicos, ureidopenicili-nas,
carbapenémicos, inh. G3G, C4G,
carbapenemasas monobactámicos y
carbapenémicos

R C1G, C2G Amino/caboxi/ureido- Inh. betalactamasa, Amino/carboxipenicilinas,

penicilinas cefoxitina, cefuroxima amoxi-ác. Clavulánico,
C1G, C2G

Mecanism E. Coli / Shigella: Betalactamasa Betalactamasa tipo C Cefalosporinasa,

o AmpC hiperproducida no cromosómica tipo A - penicilinasa
expresada penicilinasa
 Beta- lactamasas
Penicilinasa IRT BLEA BLEE AMPC

● Hidroliza Hidroliza inhibidores ● Hidroliza ● Hidroliza Hidroliza

penicilinas Resistencia: penicilina y penicilinas, penicilinas C1, C2,
● Hiperprodu amino/carboxi/ureido- C 1gen C1G, C2G, C3, C4, y
cción: penicilinas ● No afecta C3G, C4G, cefamicina
afección de Sensibilidad ↓/R a inhibidores aztreonam No afecta
inhibidores amoxi-clavulánico ● No afecta inhibidores
inhibidores ni
cefamicinas

Navarro F, Calvo J, Cantón R, Fernández-Cuenca F, Mirelis B. Detección fenotípica de mecanismos de resistencia en microorganismos gramnegativos [Detection of resistance phenotypes in gram-negative
bacteria]. Enferm Infecc Microbiol Clin. 2011 Aug-Sep;29(7):524-34. Spanish. doi: 10.1016/j.eimc.2011.03.011. Epub 2011 Jun 21. PMID: 21696863.
Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016 Apr;4(2):10.1128/microbiolspec.VMBF-0016-2015. doi: 10.1128/microbiolspec.VMBF-0016-2015. PMID:
27227291; PMCID: PMC4888801.
 Bacilos gram negativos

S R
Ceftriaxona

Ampicilina / inhibidores Carbapenémicos

S S S

Multisensible Penicilinasa R Carbapenemasas R

S R Ác. Borónico EDTA

C1G
R R

R Serín Metalo
S IRT BLEA

Cefamicinas / cefoxetin S
Hiperproducción
de penicilinasa S R
BLEE AMPc

Aztreonam R, Cefepime R, Piptazo S Aztreonam S Cefepime S, Piptazo R

Tratamiento
gracias
 Bibliografia
Cantón R. Lectura interpretada del antibiograma: una necesidad clínica [Interpretive reading of the antibiogram: a clinical necessity]. Enferm Infecc Microbiol Clin.
2010 Jun-Jul;28(6):375-85. Spanish. doi: 10.1016/j.eimc.2010.01.001. Epub 2010 Apr 9. Erratum in: Enferm Infecc Microbiol Clin. 2011 Mar;29(3):244. PMID:
20381926.
Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016 Apr;4(2):10.1128/microbiolspec.VMBF-0016-2015. doi:
10.1128/microbiolspec.VMBF-0016-2015. PMID: 27227291; PMCID: PMC4888801.
Bush K. Past and Present Perspectives on β-Lactamases. Antimicrob Agents Chemother. 2018 Sep 24;62(10):e01076-18. doi: 10.1128/AAC.01076-18. PMID:
30061284; PMCID: PMC6153792.
Wachino JI, Doi Y, Arakawa Y. Aminoglycoside Resistance: Updates with a Focus on Acquired 16S Ribosomal RNA Methyltransferases. Infect Dis Clin North Am.
2020 Dec;34(4):887-902. doi: 10.1016/j.idc.2020.06.002. Epub 2020 Sep 30. PMID: 33011054.
Lee, A., de Lencastre, H., Garau, J. et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers 4, 18033 (2018). https://doi.org/10.1038/nrdp.2018.33
Navarro F, Miró E, Mirelis B. Lectura interpretada del antibiograma de enterobacterias [Interpretive reading of enterobacteria antibiograms]. Enferm Infecc Microbiol
Clin. 2010 Nov;28(9):638-45. Spanish. doi: 10.1016/j.eimc.2010.05.002. Epub 2010 Jul 1. PMID: 20579780.
Henson KE, Levine MT, Wong EA, Levine DP. Glycopeptide antibiotics: evolving resistance, pharmacology and adverse event profile. Expert Rev Anti Infect Ther.
2015;13(10):1265-78. doi: 10.1586/14787210.2015.1068118. Epub 2015 Jul 12. PMID: 26165756.
Huang L, Crothers K, Atzori C, Benfield T, Miller R, Rabodonirina M, Helweg-Larsen J. Dihydropteroate synthase gene mutations in Pneumocystis and sulfa
resistance. Emerg Infect Dis. 2004 Oct;10(10):1721-8. doi: 10.3201/eid1010.030994. PMID: 15504256; PMCID: PMC3323267.
Lee, A. S., de Lencastre, H., Garau, J., Kluytmans, J., Malhotra-Kumar, S., Peschel, A., & Harbarth, S. (2018). Methicillin-resistant Staphylococcus aureus. Nature
Reviews Disease Primers, 4, 18033. doi:10.1038/nrdp.2018.33
Hryniewicz MM, Garbacz K. Borderline oxacillin-resistant Staphylococcus aureus (BORSA) - a more common problem than expected? J Med Microbiol. 2017
Oct;66(10):1367-1373. doi: 10.1099/jmm.0.000585. Epub 2017 Sep 12. PMID: 28893360.
McGuinness WA, Malachowa N, DeLeo FR. Vancomycin Resistance in Staphylococcus aureus
. Yale J Biol Med. 2017 Jun 23;90(2):269-281. PMID: 28656013; PMCID: PMC5482303.
Our company
Mercury is the closest planet to the
Sun and the smallest one in the
Solar System—it’s only a bit larger
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 Market share
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 Awareness
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Buyer considerati
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Age: 26
Gender: Female
Studies: Architecture
Job: Architect
Salary: $ 2000
Status: Single

skills habits Hobbies

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70% Sports
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 OUR CREATION
PROCESS
DA DA DA DA
Y 01 Y 02 Y 03 Y 04

Venus has a beautiful Despite being red, It’s the biggest Mercury is the
name, but it’s terribly Mars is actually a planet in the Solar closest planet to the
hot cold place System Sun
 DAY 01
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It’s the farthest planet Mercury is the closest
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Despite being red, Mars
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Mercury is the closest
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Jupiter
Jupiter is a gas giant and the biggest
planet in the Solar System

Neptune
It’s the fourth-largest planet by diameter
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(https://fonts.google.com/specimen/Bebas+Neue)

Overpass
(https://fonts.google.com/specimen/Overpass)

#278fd8 #ffffff
 Storyset
Create your Story with our illustrated concepts. Choose the style you like the most, edit its colors, pick
the background and layers you want to show and bring them to life with the animator panel! It will boost
your presentation. Check out How it Works.

Pana Amico Bro Rafiki Cuate

 Use our editable graphic resources...
You can easily resize these resources without losing quality. To change the color, just ungroup the resource
and click on the object you want to change. Then, click on the paint bucket and select the color you want.
Group the resource again when you’re done.
 JANUARY FEBRUARY MARCH APRIL MAY JUNE

PHASE 1

Task 1

Task 2

PHASE 2

Task 1

Task 2

JANUARY FEBRUARY MARCH APRIL

PHASE
1

Task 1

Task 2
 ...and our sets of editable icons
You can resize these icons without losing quality.
You can change the stroke and fill color; just select the icon and click on the paint bucket/pen.
In Google Slides, you can also use Flaticon’s extension, allowing you to customize and add even more icons.
Educational Icons Medical Icons
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