Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales

Las infecciones nosocomiales son causadas por una gran variedad de microorganismos que se encuentran en los ambientes hospitalarios, estos pueden ocasionar diversas patologías qué ponen en riesgo la vida del paciente o alargar los periodos de hospitalización. Se ha reportado que para el año 2018 cer...

Full description

Autores:
Sánchez Porras, Miguel Ángel
Tipo de recurso:
Trabajo de grado de pregrado
Fecha de publicación:
2022
Institución:
Colegio Mayor de Cundinamarca
Repositorio:
Repositorio Colegio Mayor de Cundinamarca
Idioma:
spa
OAI Identifier:
oai:repositorio.unicolmayor.edu.co:unicolmayor/5676
Acceso en línea:
https://repositorio.unicolmayor.edu.co/handle/unicolmayor/5676
Palabra clave:
CLSI
Infecciones nosocomiales
Multirresistencia
Pseudomonas aeruginosa
Acinetobacter baumannii
Rights
closedAccess
License
Derechos Reservados - Universidad Colegio Mayor de Cundinamarca, 2022
id UCOLMAYOR2_1b400c070666afedcc0d97d6f24a29e7
oai_identifier_str oai:repositorio.unicolmayor.edu.co:unicolmayor/5676
network_acronym_str UCOLMAYOR2
network_name_str Repositorio Colegio Mayor de Cundinamarca
repository_id_str
dc.title.spa.fl_str_mv Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
title Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
spellingShingle Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
CLSI
Infecciones nosocomiales
Multirresistencia
Pseudomonas aeruginosa
Acinetobacter baumannii
title_short Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
title_full Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
title_fullStr Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
title_full_unstemmed Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
title_sort Estudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales
dc.creator.fl_str_mv Sánchez Porras, Miguel Ángel
dc.contributor.advisor.none.fl_str_mv Cubillos Abello, Karen Andrea
dc.contributor.author.none.fl_str_mv Sánchez Porras, Miguel Ángel
dc.subject.lemb.none.fl_str_mv CLSI
Infecciones nosocomiales
Multirresistencia
topic CLSI
Infecciones nosocomiales
Multirresistencia
Pseudomonas aeruginosa
Acinetobacter baumannii
dc.subject.proposal.spa.fl_str_mv Pseudomonas aeruginosa
dc.subject.proposal.eng.fl_str_mv Acinetobacter baumannii
description Las infecciones nosocomiales son causadas por una gran variedad de microorganismos que se encuentran en los ambientes hospitalarios, estos pueden ocasionar diversas patologías qué ponen en riesgo la vida del paciente o alargar los periodos de hospitalización. Se ha reportado que para el año 2018 cerca del 14% de las infecciones nosocomiales en el mundo fueron asociadas a Pseudomonas aeruginosa (P. aeruginosa) un 11% y Acinetobacter baumannii (A. baumannii ) 3%, así mismo se ha encontrado que estos microorganismos tienen la capacidad de desarrollar mecanismos de resistencia con los cuales son capaces de resistir a variedad de los antibióticos creados para su tratamiento. La multirresistencia de estos microorganismos ha ocasionado que la Organización Mundial de la Salud (OMS) en el 2017 los declaró de prioridad crítica. En P. aeruginosa y A. baumannii se han encontrado como principales mecanismos de resistencia intrínsecos la pérdida de porinas, las bombas de eflujo y la producción de betalactamasas, siendo estas últimas, también el principal mecanismo de resistencia adquirida. Con este trabajo se pretende profundizar en los mecanismos de resistencia presentados en estos microorganismos y así mismo, dar a conocer las técnicas fenotípicas para su identificación, avaladas por el instituto de estándares clínicos y de laboratorio (CLSI por sus siglas en inglés).
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-10-03T20:26:25Z
dc.date.available.none.fl_str_mv 2022-10-03T20:26:25Z
dc.date.issued.none.fl_str_mv 2022
dc.type.spa.fl_str_mv Trabajo de grado - Pregrado
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.coarversion.spa.fl_str_mv http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.redcol.spa.fl_str_mv https://purl.org/redcol/resource_type/TP
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/publishedVersion
format http://purl.org/coar/resource_type/c_7a1f
status_str publishedVersion
dc.identifier.uri.none.fl_str_mv https://repositorio.unicolmayor.edu.co/handle/unicolmayor/5676
url https://repositorio.unicolmayor.edu.co/handle/unicolmayor/5676
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv Alejandro Alfonso C, María Blandón Rodríguez A, Lucía Ospina Martínez M, Edwin Prieto Alvarado F, Eduardo Pacheco García Ó, Quijada Bonilla H. Infecciones intrahospitalarias.
Kukso F. Para 2050 la resistencia a los antibióticos será la principal causa de muerte - Scientific American - Español. Sci Am [Internet]. 2016 [cited 2022 Mar 30];(26 de julio del 2016). Available from: https://www.scientificamerican.com/espanol/noticias/para-2050-la-resistencia-a-los-antibiot icos-sera-la-principal-causa-de-muerte/
Garza-Ramos U, Barrios H, Reyna-Flores F, Tamayo-Legorreta E, Catalan-Najera JC, Morfin-Otero R, et al. Informe De Resultados De La Vigilancia Por Laboratorio De Resistencia Antimicrobiana En Infecciones Asociadas a La Atención En Salud (Iaas) 2018 Dirección. Epidemiol las Infecc Asoc a la atención en salud. 2019;81(2):1–28.
Miltgen G, Bour M, Allyn J, Allou N, Vedani T, Vuillemenot J-B, et al. Molecular and epidemiological investigation of a colistin-resistant OXA-23/NDM-1-producing Acinetobacter baumannii outbreak in Southwest Indian Ocean. Int J Antimicrob Agents [Internet]. 2021 Jul 19 [cited 2021 Jul 29];106402. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0924857921001679
Yaumara Aguilera Calzadilla, Yayquier Díaz Morales, Leonardo Abilio Ortiz Díaz, Olga Linee Gonzalez Martínez, Orlando Adolfo Lovelle Enríquez, María de Lourdes Sánchez Álvarez. Infecciones bacterianas asociadas a la COVID-19 en pacientes de una unidad de cuidados intensivos | Aguilera Calzadilla | Revista Cubana de Medicina Militar. Rev Cuba Med Mil [Internet]. 2020 [cited 2022 Mar 7];49(3). Available from: http://www.revmedmilitar.sld.cu/index.php/mil/article/view/793/539
Barie PS. Multidrug-Resistant Organisms and Antibiotic Management. Vol. 92, Surgical Clinics of North America. Elsevier; 2012. p. 345–91.
Oliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244e
Ávila-Torres YY, Cáceres-Rojas MF, Aguilera-Becerra AM. Infecciones asociadas a dispositivos, perfil microbiológico y resistencia bacteriana en unidades de cuidados intensivos de Casanare - Colombia. Rev Investig en Salud Univ Boyacá [Internet]. 2021 [cited 2022 Mar 15];8(2). Available from: https://revistasdigitales.uniboyaca.edu.co/index.php/rs/article/view/640/636
Mamishi S, Mahmoudi S, Naserzadeh N, Sadeghi RH, Ashtiani MTH, Bahador A, et al. Antibiotic resistance and genotyping of gram-negative bacteria causing hospital-acquired infection in patients referred to children’s medical center. Infect Drug Resist [Internet]. 2019 [cited 2021 Aug 22];12:3377–84. Available from: /pmc/articles/PMC6825472/
Hu HB, Huang HJ, Peng QY, Lu J, Lei XY. Prospective study of colonization and infection because of Pseudomonas aeruginosa in mechanically ventilated patients at a neonatal intensive care unit in China. Am J Infect Control. 2010 Nov 1;38(9):746–50
Suárez C, Peña C, Gavaldà L, Tubau F, Manzur A, Dominguez MA, et al. Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection. Int J Infect Dis. 2010 Sep 1;14(SUPPL. 3):e73–8.
Pang Z, Raudonis R, Glick BR, Lin TJ, Cheng Z. Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and alternative therapeutic strategies. Biotechnol Adv. 2019 Jan 1;37(1):177–92.
Mercado-Tobio Luisa Fernanda, Martínez Orfa Contreras, Angulo-Ortiz Alberto. EVALUACIÓN DE LA ACTIVIDAD ANTIBIOPELÍCULA DE LOS EXTRACTOS DE Trichilia hirta L. FRENTE AISLADOS CLÍNICOS DE Pseudomona aeruginosa EN MONTERÍACÓRDOBA [Internet]. Universidad de Córdoba. Facultad de Ciencias Básicas. Laboratorio de Productos Naturales. [Cordoba]: Universidad de cordoba; 2020 [cited 2021 Sep 5]. Available from: https://repositorio.unicordoba.edu.co/bitstream/handle/ucordoba/3569/MercadoTobioLuisa Fernanda-ContrerasMartínezOrfaInés-ÁnguloOrtízAlbertoAntonio.pdf?sequence=1&isAllo wed=y
Gaete ME, Valenzuela MP, Bachero AW, Vega CC, Marín NV, Labarca JL, et al. Carbapenemasas en Pseudomonas aeruginosa con susceptibilidad disminuida a los carbapenémicos después de una década, desde VIM a KPC. Rev Chil infectología [Internet]. 2020 Aug 1 [cited 2021 Sep 12];37(4):389–94. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182020000400389&lng= es&nrm=iso&tlng=es
Asif M, Alvi IA, Ur Rehman S. Insight into acinetobacter baumannii: Pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities [Internet]. Vol. 11, Infection and Drug Resistance. Dove Press; 2018 [cited 2021 Aug 22]. p. 1249–60. Available from: /pmc/articles/PMC6110297/
Ribeiro LF, Lopes EM, Kishi LT, Ribeiro LFC, Menegueti MG, Gaspar GG, et al. Microbial community profiling in intensive care units expose limitations in current sanitary standards. Front Public Heal. 2019;7(AUG):240
Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence [Internet]. Vol. 16, Nature Reviews Microbiology. NIH Public Access; 2018 [cited 2021 Aug 22]. p. 91–102. Available from: /pmc/articles/PMC6571207/
Cendra M del M, Torrents E. Pseudomonas aeruginosa biofilms and their partners in crime. Biotechnol Adv. 2021 Jul 1;49:107734.
Pujol M, Limón E. Epidemiología general de las infecciones nosocomiales. Sistemas y programas de vigilancia. Enferm Infecc Microbiol Clin [Internet]. 2013 Feb 1 [cited 2021 Aug 29];31(2):108–13. Available from: https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-artic ulo-epidemiologia-general-infecciones-nosocomiales-sistemas-S0213005X13000025
Angeletti S, Cella E, Prosperi M, Spoto S, Fogolari M, De Florio L, et al. Multi-drug resistant Pseudomonas aeruginosa nosocomial strains: Molecular epidemiology and evolution. Microb Pathog. 2018 Oct 1;123:233–41.
Llanos-Torres KH, Pérez-Orozco R, Málaga G. Infecciones nosocomiales en unidades de observación de emergencia y su asociación con el hacinamiento y la ventilación. Rev Peru Med Exp Salud Publica [Internet]. 2020 Oct 13 [cited 2021 Sep 13];37(4):721–5. Available from: https://rpmesp.ins.gob.pe/rpmesp/article/view/5192/4010
Rosales C, Francesconi GV, Molina J, Listovsky G, Carvalho C, Kemper ES, et al. Sistema Integrado de Informações Mais Médicos: uma ferramenta de suporte à gestão baseada em evidências. Rev Panam Salud Pública. 2020;1–7.
da Costa JST, Lima CA, Vera-Leiva A, San Martin Magdalena I, Bello-Toledo H, Domínguez Yévenes M, et al. Carbapenemasas en aislamientos de Pseudomonas aeruginosa resistentes a carbapenémicos aisladas en hospitales de Chile. Rev Chil infectología [Internet]. 2021 [cited 2022 Feb 14];38(1):81–7. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182021000100081&lng= es&nrm=iso&tlng=es
Kostyanev T, Xavier BB, García-Castillo M, Lammens C, Bravo-Ferrer Acosta J, Rodríguez-Baño J, et al. Phenotypic and molecular characterizations of carbapenem-resistant Acinetobacter baumannii isolates collected within the EURECA study. Int J Antimicrob Agents. 2021 Jun 1;57(6):106345.
Nikibakhsh M, Firoozeh F, Badmasti F, Kabir K, Zibaei M. Molecular study of metallo-β-lactamases and integrons in Acinetobacter baumannii isolates from burn patients. BMC Infect Dis. 2021 Dec 1;21(1).
Guner Ozenen G, Sahbudak Bal Z, Umit Z, Avcu G, Tekin D, Kurugol Z, et al. Nosocomial Non-fermentative gram negative bacteria bloodstream infections in children; Risk factors and clinical outcomes of carbapenem resistance. J Infect Chemother. 2021 May 1;27(5):729–35
Yamani L, Alamri A, Alsultan A, Alfifi S, Ansari MA, Alnimr A. Inverse correlation between biofilm production efficiency and antimicrobial resistance in clinical isolates of Pseudomonas aeruginosa. Microb Pathog. 2021 Aug 1;157:104989.
Ropponen HK, Richter R, Hirsch AKH, Lehr CM. Mastering the Gram-negative bacterial barrier – Chemical approaches to increase bacterial bioavailability of antibiotics. Adv Drug Deliv Rev. 2021 May 1;172:339–60.
Chen J, Zhou R, Li Z, Li Q, Long Y, Wang H, et al. Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection. Int J Infect Dis. 2021 Feb 1;103:167–72
Yadav SK, Bhujel R, Hamal P, Mishra SK, Sharma S, Sherchand JB. Burden of multidrug-resistant acinetobacter baumannii infection in hospitalized patients in a tertiary care hospital of Nepal. Infect Drug Resist [Internet]. 2020 [cited 2021 Aug 22];13:725–32. Available from: /pmc/articles/PMC7061726/
Kurihara MNL, Sales RO de, Silva KE da, Maciel WG, Simionatto S. Multidrug-resistant Acinetobacter baumanniioutbreaks: a global problem in healthcare settings. Rev Soc Bras Med Trop [Internet]. 2020 [cited 2021 Aug 22];53:e20200248. Available from: /pmc/articles/PMC7670754/
Rosales C, Francesconi GV, Molina J, Listovsky G, Carvalho C, Kemper ES, et al. Sistema Integrado de Informações Mais Médicos: uma ferramenta de suporte à gestão baseada em evidências. Rev Panam Salud Pública. 2020;1–7.
da Costa JST, Lima CA, Vera-Leiva A, San Martin Magdalena I, Bello-Toledo H, Domínguez Yévenes M, et al. Carbapenemasas en aislamientos de Pseudomonas aeruginosa resistentes a carbapenémicos aisladas en hospitales de Chile. Rev Chil infectología [Internet]. 2021 [cited 2022 Feb 14];38(1):81–7. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182021000100081&lng= es&nrm=iso&tlng=es
Cipko K, Kizny Gordon A, Adhikari S, Konecny P. Cefiderocol treatment of Pseudomonas aeruginosa and extensively drug-resistant Acinetobacter baumannii retained spinal hardware infection causing reversible acute interstitial nephritis: Recto: Cefiderocol causing acute interstitial nephritis. Int J Infect Dis. 2021 Aug 1;109:108–11.
Subedi D, Vijay AK, Willcox M. Overview of mechanisms of antibiotic resistance in Pseudomonas aeruginosa: an ocular perspective. https://doi.org/101111/cxo12621 [Internet]. 2021 Mar 1 [cited 2021 Sep 20];101(2):162–71. Available from: https://www.tandfonline.com/doi/abs/10.1111/cxo.12621
Asenjo A, Oteo-Iglesias J, Alós J-I. What’s new in mechanisms of antibiotic resistance in bacteria of clinical origin? Enfermedades Infecc y Microbiol Clin (English ed). 2021 Jun 1;39(6):291–9.
Rosales-Reyes R, Vargas-Roldán SY, Lezana-Fernández JL, Santos-Preciado JI. Pseudomonas Aeruginosa: Genetic Adaptation, A Strategy for its Persistence in Cystic Fibrosis. Arch Med Res. 2021 May 1;52(4):357–61
Huang X, Li T, Zhang X, Deng J, Yin X. Bimetallic palladium@copper nanoparticles: Lethal effect on the gram-negative bacterium Pseudomonas aeruginosa. Mater Sci Eng C. 2021 Oct 1;129:112392.
Bashir A, Brown JS. Pseudomonas aeruginosa. Ref Modul Biomed Sci [Internet]. 2021 Jan 1 [cited 2021 Sep 10]; Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780081027233002584
Crémet L, Leroy AG, Muller D, Delanou S, Burghelea A, Broquet A, et al. Antibiotic resistance heterogeneity and LasR diversity within Pseudomonas aeruginosa populations from pneumonia in intensive care unit patients. Int J Antimicrob Agents. 2021 Jun 1;57(6):106341
Li Y, Xia L, Chen J, Lian Y, Dandekar AA, Xu F, et al. Resistance elicited by sub-lethal concentrations of ampicillin is partially mediated by quorum sensing in Pseudomonas aeruginosa. Environ Int. 2021 Nov 1;156:106619.
Khademi F, Maarofi K, Arzanlou M, Peeri-Dogaheh H, Sahebkar A. Which missense mutations associated with DNA gyrase and topoisomerase IV are involved in Pseudomonas aeruginosa clinical isolates resistance to ciprofloxacin in Ardabil? Gene Reports. 2021 Sep 1;24:101211.
Abavisani M, Goudarzi M, Ghalavand Z, Hajikhani B, Rad ZR, Rad ZR, et al. Evaluation of efflux pumps overexpression and β-lactamase genes among colistin resistant Pseudomonas aeruginosa. Gene Reports. 2021 Sep 1;24:101301.
Zahedi bialvaei A, Rahbar M, Hamidi-Farahani R, Asgari A, Esmailkhani A, Mardani dashti Y, et al. Expression of RND efflux pumps mediated antibiotic resistance in Pseudomonas aeruginosa clinical strains. Microb Pathog. 2021 Apr 1;153:104789.
Tang B, Yang H, Jia X, Feng Y. Coexistence and characterization of Tet(X5) and NDM-3 in the MDR-Acinetobacter indicus of duck origin. Microb Pathog. 2021 Jan 1;150:104697.
Snyman Y, Reuter S, Whitelaw AC, Stein L, Maloba MRB, Newton-Foot M. Characterisation of mcr-4.3 in a colistin-resistant Acinetobacter nosocomialis clinical isolate from Cape Town, South Africa. J Glob Antimicrob Resist. 2021 Jun 1;25:102–6
Chen J, Zhou R, Li Z, Li Q, Long Y, Wang H, et al. Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection. Int J Infect Dis. 2021 Feb 1;103:167–72
König P, Averhoff B, Müller V. K+ and its role in virulence of Acinetobacter baumannii. Int J Med Microbiol. 2021 Jul 1;311(5):151516.
Li Y, Peng C, Zhao D, Liu L, Guo B, Shi M, et al. Outer membrane protein A inhibits the degradation of caspase-1 to regulate NLRP3 inflammasome activation and exacerbate the Acinetobacter baumannii pulmonary inflammation. Microb Pathog. 2021 Apr 1;153:104788.
Hao M, Ma W, Dong X, Li X, Cheng F, Wang Y. Comparative genome analysis of multidrug-resistant Pseudomonas aeruginosa JNQH-PA57, a clinically isolated mucoid strain with comprehensive carbapenem resistance mechanisms. BMC Microbiol. 2021 Dec 1;21(1):1–16
Mea HJ, Yong PVC, Wong EH. An overview of Acinetobacter baumannii pathogenesis: Motility, adherence and biofilm formation. Microbiol Res. 2021 Jun 1;247:126722.
Kostyanev T, Xavier BB, García-Castillo M, Lammens C, Bravo-Ferrer Acosta J, Rodríguez-Baño J, et al. Phenotypic and molecular characterizations of carbapenem-resistant Acinetobacter baumannii isolates collected within the EURECA study. Int J Antimicrob Agents. 2021 Jun 1;57(6):106345.
Elbehiry A, Marzouk E, Moussa IM, Dawoud TM, Mubarak AS, Al-Sarar D, et al. Acinetobacter baumannii as a community foodborne pathogen: Peptide mass fingerprinting analysis, genotypic of biofilm formation and phenotypic pattern of antimicrobial resistance. Saudi J Biol Sci. 2021 Jan 1;28(1):1158–66.
Yamani L, Alamri A, Alsultan A, Alfifi S, Ansari MA, Alnimr A. Inverse correlation between biofilm production efficiency and antimicrobial resistance in clinical isolates of Pseudomonas aeruginosa. Microb Pathog. 2021 Aug 1;157:104989.
Shan W, Zhang H, Kan J, Yin M, Zhang J, Wan L, et al. Acquired mucoid phenotype of Acinetobacter baumannii: Impact for the molecular characteristics and virulence. Microbiol Res. 2021 May 1;246:126702
Bedenić B, Meštrović T. Mechanisms of resistance in gram-negative urinary pathogens: From country-specific molecular insights to global clinical relevance. Diagnostics. 2021;11(5).
Nikibakhsh M, Firoozeh F, Badmasti F, Kabir K, Zibaei M. Molecular study of metallo-β-lactamases and integrons in Acinetobacter baumannii isolates from burn patients. BMC Infect Dis. 2021 Dec 1;21(1).
Oliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244e
Oliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244e
Edwards F, MacGowan A, Macnaughton E. Antibiotic resistance [Internet]. Vol. 49, Medicine (United Kingdom). Elsevier; 2021 [cited 2021 Sep 5]. p. 1–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1357303921001985
Henderson A, Bursle E, Stewart A, Harris PNA, Paterson D, Chatfield MD, et al. A systematic review of antimicrobial susceptibility testing as a tool in clinical trials assessing antimicrobials against infections due to gram-negative pathogens. Clinical Microbiology and Infection. Elsevier; 2021
Guner Ozenen G, Sahbudak Bal Z, Umit Z, Avcu G, Tekin D, Kurugol Z, et al. Nosocomial Non-fermentative gram negative bacteria bloodstream infections in children; Risk factors and clinical outcomes of carbapenem resistance. J Infect Chemother. 2021 May 1;27(5):729–35
Freire MP, Song ATW, Oshiro ICV, Andraus W, D’Albuquerque LAC, Abdala E. Surgical site infection after liver transplantation in the era of multidrug-resistant bacteria: what new risks should be considered? Diagn Microbiol Infect Dis. 2021 Jan 1;99(1):115220.
Bayraktar M, Kaya E, Ozturk A, İbahim BMS. Antimicrobial susceptibility of bacterial pathogens isolated from healthcare workers’ cellphones. Infect Dis Now. 2021 Jun 4
Ropponen HK, Richter R, Hirsch AKH, Lehr CM. Mastering the Gram-negative bacterial barrier – Chemical approaches to increase bacterial bioavailability of antibiotics. Adv Drug Deliv Rev. 2021 May 1;172:339–60
Pandit P, Sahni AK, Grover N, Dudhat V, Das NK, Biswas AK. Catheter-related blood stream infections: prevalence, risk factors and antimicrobial resistance pattern. Med J Armed Forces India. 2021 Jan 1;77(1):38–45.
Alharbi NM, Ziadi MM. Wastewater as a fertility source for novel bacteriophages against multi-drug resistant bacteria. Vol. 28, Saudi Journal of Biological Sciences. Elsevier; 2021. p. 4358–64.
Herbert R, Curtis C. Commonly encountered central nervous system infections in the neurointensive care unit. Anaesth Intensive Care Med. 2021 Feb 1;22(2):89–94.
Saidin S, Jumat MA, Mohd Amin NAA, Saleh Al-Hammadi AS. Organic and inorganic antibacterial approaches in combating bacterial infection for biomedical application. Mater Sci Eng C. 2021 Jan 1;118:111382.
Sambrano H, Castillo JC, Ramos CW, de Mayorga B, Chen O, Durán O, et al. Prevalence of antibiotic resistance and virulent factors in nosocomial clinical isolates of Pseudomonas aeruginosa from Panamá. Brazilian J Infect Dis. 2021 Jan 1;25(1):101038.
Gouveia e Melo R, Martins B, Pedro DM, Santos CM, Duarte A, Fernandes e Fernandes R, et al. Microbial evolution of vascular graft infections in a tertiary hospital based on positive graft cultures. J Vasc Surg. 2021 Jul 1;74(1):276-284.e4.
Aboelenin AM, Hassan R, Abdelmegeed ES. The effect of EDTA in combination with some antibiotics against clinical isolates of gram negative bacteria in Mansoura, Egypt. Microb Pathog. 2021 May 1;154:104840.
Saharman YR, Karuniawati A, Sedono R, Aditianingsih D, Qi H, Verbrugh HA, et al. Multimodal intervention to reduce acquisition of carbapenem-non-susceptible Gram-negative bacteria in intensive care units in the National Referral Hospital of Indonesia: An interrupted time series study. J Crit Care. 2021 Aug 1;64:237–44
Cantón R, Huarte R, Morata L, Trillo-Mata JL, Muñoz R, González J, et al. Determining the burden of infectious diseases caused by carbapenem-resistant gram-negative bacteria in Spain. Enfermedades Infecc y Microbiol Clin (English ed). 2021 Apr 1;39(4):179–83.
Almangour TA, Alruwaili A, Almutairi R, Alrasheed A, Alhifany AA, Eljaaly K, et al. Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study. Int J Infect Dis. 2021 Jul 1;108:406–12
Miltgen G, Bour M, Allyn J, Allou N, Vedani T, Vuillemenot J-B, et al. Molecular and epidemiological investigation of a colistin-resistant OXA-23/NDM-1-producing Acinetobacter baumannii outbreak in Southwest Indian Ocean. Int J Antimicrob Agents [Internet]. 2021 Jul 19 [cited 2021 Jul 29];106402. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0924857921001679
Cendra M del M, Torrents E. Pseudomonas aeruginosa biofilms and their partners in crime. Biotechnol Adv. 2021 Jul 1;49:107734
Jackson L, Waters V. Factors influencing the acquisition and eradication of early Pseudomonas aeruginosa infection in cystic fibrosis. J Cyst Fibros. 2021 Jan 1;20(1):8–16.
Santos Rosado Castro M, da Silva Fernandes M, Kabuki DY, Kuaye AY. Modelling Pseudomonas fluorescens and Pseudomonas aeruginosa biofilm formation on stainless steel surfaces and controlling through sanitisers. Int Dairy J. 2021 Mar 1;114:104945.
Santos Rosado Castro M, da Silva Fernandes M, Kabuki DY, Kuaye AY. Modelling Pseudomonas fluorescens and Pseudomonas aeruginosa biofilm formation on stainless steel surfaces and controlling through sanitisers. Int Dairy J. 2021 Mar 1;114:104945.
Hosseinkhan N, Allahverdi A, Abdolmaleki F. The novel potential multidrug-resistance biomarkers for Pseudomonas aeruginosa lung infections using transcriptomics data analysis. Informatics Med Unlocked. 2021 Jan 1;22:100509.
McAulay K, Schuetz AN, Fauntleroy K, Shen L, Merveille YM, Deroncelay A, et al. Multidrug-resistant Pseudomonas aeruginosa in healthcare facilities in Port-au-Prince, Haiti. J Glob Antimicrob Resist. 2021 Jun 1;25:60–5
Abozahra R, El-Kholy MA, Baraka K. Virulence genotyping of drug resistant Pseudomonas aeruginosa clinical isolates in Egypt using multiplex PCR. Gene Reports. 2021 Mar 1;22:101000
Rad ZR, Rad ZR, Goudarzi H, Goudarzi M, Alizade H, Hematian A, et al. Detection of New Delhi Metallo-β-lactamase-1 among Pseudomonas aeruginosa isolated from adult and Pediatric patients in Iranian hospitals. Gene Reports. 2021 Jun 1;23:101152.
Tchakal-Mesbahi A, Metref M, Singh VK, Almpani M, Rahme LG. Characterization of antibiotic resistance profiles in Pseudomonas aeruginosa isolates from burn patients. Burns [Internet]. 2021 Mar 17 [cited 2021 Jul 29];12(1):15–22. Available from: https://www.mendeley.com/catalogue/563c3a31-1ae2-3f1c-b5b6-0be19bbc70a6/?utm_sour ce=desktop&utm_medium=1.19.8&utm_campaign=open_catalog&userDocumentId=%7Bc a78cba7-035a-3cca-86db-be52f38cd985%7D
Mkwata HM, Omoregie AI, Nissom PM. Lytic bacteriophages isolated from limestone caves for biocontrol of Pseudomonas aeruginosa. Biocatal Agric Biotechnol. 2021 Jul 1;34:102011.
Ali KM, Al-Jaff BMA. Source and antibiotic susceptibility of gram-negative bacteria causing superficial incisional surgical site infections. Int J Surg Open. 2021 Mar 1;30:100318.
Lim WY, Tan GSE, Htun HL, Phua HP, Kyaw WM, Guo H, et al. First nosocomial cluster of COVID-19 due to the Delta variant in a major acute care hospital in Singapore: investigations and outbreak response. J Hosp Infect. 2022 Apr 1;122:27–34
Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs Context [Internet]. 2018 [cited 2022 Mar 31];7:212527. Available from: /pmc/articles/PMC5978525/
Almangour TA, Alruwaili A, Almutairi R, Alrasheed A, Alhifany AA, Eljaaly K, et al. Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study. Int J Infect Dis. 2021 Jul 1;108:406–12.
dc.rights.eng.fl_str_mv Derechos Reservados - Universidad Colegio Mayor de Cundinamarca, 2022
dc.rights.uri.spa.fl_str_mv https://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rights.accessrights.spa.fl_str_mv info:eu-repo/semantics/closedAccess
dc.rights.creativecommons.spa.fl_str_mv Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
dc.rights.coar.spa.fl_str_mv http://purl.org/coar/access_right/c_14cb
rights_invalid_str_mv Derechos Reservados - Universidad Colegio Mayor de Cundinamarca, 2022
https://creativecommons.org/licenses/by-nc-sa/4.0/
Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
http://purl.org/coar/access_right/c_14cb
eu_rights_str_mv closedAccess
dc.format.extent.spa.fl_str_mv 70
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.publisher.faculty.spa.fl_str_mv Facultad de Ciencias de la Salud
dc.publisher.place.spa.fl_str_mv Bogota
dc.publisher.program.spa.fl_str_mv Bacteriología y Laboratorio Clínico
institution Colegio Mayor de Cundinamarca
bitstream.url.fl_str_mv https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/5/license.txt
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/6/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf.txt
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/8/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf.txt
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/10/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdf.txt
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/12/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf.txt
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/7/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf.jpg
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/9/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf.jpg
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/11/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdf.jpg
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/13/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf.jpg
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/1/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/2/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/3/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdf
https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/4/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf
bitstream.checksum.fl_str_mv 2f9959eaf5b71fae44bbf9ec84150c7a
a7758c7df0fdc1cf66286a99113fc431
47c17ba8c58018746a74fdfdb56430c1
985053829f1d56185969e76a23459c63
450c6d00976d55bce98b0dae1cc3b158
58459015af4d1096f94ca72ac5ae5284
5e49c21f279377c8cc572e867f0c6e7d
cfda89e18dafff84a1340089e0f9e5b7
30d575425086823d3713b92d98243a96
5f35bf303cb509976311d4520cc95985
3553f79c326c0156f11a366984d4b409
d55b5a7dcb291af36f3e91fda054ee06
0396286ce8d6bfb8b25b2f6a581f5905
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
MD5
repository.name.fl_str_mv Biblioteca Digital Unicolmayor
repository.mail.fl_str_mv repositorio@unicolmayor.edu.co
_version_ 1812210060854558720
spelling Cubillos Abello, Karen Andreaf71946bf2da83d9e98b944416a313c28600Sánchez Porras, Miguel Ángel5ecec1ca7a56197ff31d4f85c589169b6002022-10-03T20:26:25Z2022-10-03T20:26:25Z2022https://repositorio.unicolmayor.edu.co/handle/unicolmayor/5676Las infecciones nosocomiales son causadas por una gran variedad de microorganismos que se encuentran en los ambientes hospitalarios, estos pueden ocasionar diversas patologías qué ponen en riesgo la vida del paciente o alargar los periodos de hospitalización. Se ha reportado que para el año 2018 cerca del 14% de las infecciones nosocomiales en el mundo fueron asociadas a Pseudomonas aeruginosa (P. aeruginosa) un 11% y Acinetobacter baumannii (A. baumannii ) 3%, así mismo se ha encontrado que estos microorganismos tienen la capacidad de desarrollar mecanismos de resistencia con los cuales son capaces de resistir a variedad de los antibióticos creados para su tratamiento. La multirresistencia de estos microorganismos ha ocasionado que la Organización Mundial de la Salud (OMS) en el 2017 los declaró de prioridad crítica. En P. aeruginosa y A. baumannii se han encontrado como principales mecanismos de resistencia intrínsecos la pérdida de porinas, las bombas de eflujo y la producción de betalactamasas, siendo estas últimas, también el principal mecanismo de resistencia adquirida. Con este trabajo se pretende profundizar en los mecanismos de resistencia presentados en estos microorganismos y así mismo, dar a conocer las técnicas fenotípicas para su identificación, avaladas por el instituto de estándares clínicos y de laboratorio (CLSI por sus siglas en inglés).Tabla de contenido Índice de figuras 1 Índice de Tablas 2 Índice de anexos 3 Resumen 4 Introducción 5 Objetivos 7 Objetivo general 7 Objetivos específicos 7 1. Antecedentes 8 2. Marco referencial 13 2.1 Infecciones nosocomiales 13 2.2 Pared celular de los bacilos gram negativos 14 2.3 Bacilos gram negativos no fermentadores 15 2.4 Complejo A. baumannii/calcoaceticus 16 2.4.1 Mecanismos de resistencia intrínsecos 17 2.4.1.1 Betalactamasas tipo ADC 17 2.4.1.2 Betalactamasas tipo OXA 18 2.4.1.3 Pérdida de porinas 18 2.4.1.4 Bombas de eflujo 19 2.4.2 Mecanismo de resistencia adquirido 19 2.4.2.1 Betalactamasas 20 2.4.2.2 Betalactamasas de espectro extendido (BLEE) 20 2.4.2.3 Serinocarbapenemasas clase A 21 2.4.2.4 Serinocarbapenemasas clase D 21 2.4.2.5 Metalocarbapenemasas clase B 21 2.4.2.6 Enzimas modificadoras de aminoglucósidos 22 2.5 P. aeruginosa 22 2.5.1 Mecanismos de resistencia natural 23 2.5.1.1 Betalactamasas cromosómicas tipo PDC 24 2.5.1.2 Bombas de eflujo 24 2.5.1.3 Pérdida de la porinas 25 2.5.2 Mecanismos de resistencia adquiridos 25 2.5.2.1 Serinocarbapenemasas tipo A 25 2.5.2.2 Serinocarbapenemasas tipo D 26 2.5.2.3 Metalobetalactamasas tipo B 26 2.5.2.4 Betalactamasa de espectro extendido BLEE 27 2.5.2.5 Enzimas modificadoras de aminoglucósidos (EMA) 27 2.5.2.6 Metilasas del ARNr16S 27 2.6 Métodos de identificación fenotípica de betalactamasas según el manual de la CLSI29 2.6.1 Método de difusión en disco o método de Kirby-Bauer 29 2.6.2 Test de sinergia de doble disco 30 2.6.3 Test modificado de inactivación de carbapenémicos 31 2.6.4 Carba NP 32 2.6.5 Microdilución en caldo 33 2.6.6 Técnica molecular GeneXpert Carba 34 2.6.7 Reacción en cadena dela polimerasa en tiempo real o qPCR 35 3. Diseño metodológico 36 3.1 Tipo de investigación 36 3.2 Nivel o alcance de la investigación 36 3.3 Población objeto de muestra 36 3.4 Muestra de análisis 36 4. Resultados 38 5. Discusión 45 6. Conclusiones 51 7. Referencias bibliográficas 52PregradoBacteriólogo(a) y Laboratorista Clínico70application/pdfspaDerechos Reservados - Universidad Colegio Mayor de Cundinamarca, 2022https://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/closedAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_14cbEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomialesTrabajo de grado - Pregradohttp://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/version/c_970fb48d4fbd8a85Textinfo:eu-repo/semantics/bachelorThesishttps://purl.org/redcol/resource_type/TPinfo:eu-repo/semantics/publishedVersionFacultad de Ciencias de la SaludBogotaBacteriología y Laboratorio ClínicoAlejandro Alfonso C, María Blandón Rodríguez A, Lucía Ospina Martínez M, Edwin Prieto Alvarado F, Eduardo Pacheco García Ó, Quijada Bonilla H. Infecciones intrahospitalarias.Kukso F. Para 2050 la resistencia a los antibióticos será la principal causa de muerte - Scientific American - Español. Sci Am [Internet]. 2016 [cited 2022 Mar 30];(26 de julio del 2016). Available from: https://www.scientificamerican.com/espanol/noticias/para-2050-la-resistencia-a-los-antibiot icos-sera-la-principal-causa-de-muerte/Garza-Ramos U, Barrios H, Reyna-Flores F, Tamayo-Legorreta E, Catalan-Najera JC, Morfin-Otero R, et al. Informe De Resultados De La Vigilancia Por Laboratorio De Resistencia Antimicrobiana En Infecciones Asociadas a La Atención En Salud (Iaas) 2018 Dirección. Epidemiol las Infecc Asoc a la atención en salud. 2019;81(2):1–28.Miltgen G, Bour M, Allyn J, Allou N, Vedani T, Vuillemenot J-B, et al. Molecular and epidemiological investigation of a colistin-resistant OXA-23/NDM-1-producing Acinetobacter baumannii outbreak in Southwest Indian Ocean. Int J Antimicrob Agents [Internet]. 2021 Jul 19 [cited 2021 Jul 29];106402. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0924857921001679Yaumara Aguilera Calzadilla, Yayquier Díaz Morales, Leonardo Abilio Ortiz Díaz, Olga Linee Gonzalez Martínez, Orlando Adolfo Lovelle Enríquez, María de Lourdes Sánchez Álvarez. Infecciones bacterianas asociadas a la COVID-19 en pacientes de una unidad de cuidados intensivos | Aguilera Calzadilla | Revista Cubana de Medicina Militar. Rev Cuba Med Mil [Internet]. 2020 [cited 2022 Mar 7];49(3). Available from: http://www.revmedmilitar.sld.cu/index.php/mil/article/view/793/539Barie PS. Multidrug-Resistant Organisms and Antibiotic Management. Vol. 92, Surgical Clinics of North America. Elsevier; 2012. p. 345–91.Oliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244eÁvila-Torres YY, Cáceres-Rojas MF, Aguilera-Becerra AM. Infecciones asociadas a dispositivos, perfil microbiológico y resistencia bacteriana en unidades de cuidados intensivos de Casanare - Colombia. Rev Investig en Salud Univ Boyacá [Internet]. 2021 [cited 2022 Mar 15];8(2). Available from: https://revistasdigitales.uniboyaca.edu.co/index.php/rs/article/view/640/636Mamishi S, Mahmoudi S, Naserzadeh N, Sadeghi RH, Ashtiani MTH, Bahador A, et al. Antibiotic resistance and genotyping of gram-negative bacteria causing hospital-acquired infection in patients referred to children’s medical center. Infect Drug Resist [Internet]. 2019 [cited 2021 Aug 22];12:3377–84. Available from: /pmc/articles/PMC6825472/Hu HB, Huang HJ, Peng QY, Lu J, Lei XY. Prospective study of colonization and infection because of Pseudomonas aeruginosa in mechanically ventilated patients at a neonatal intensive care unit in China. Am J Infect Control. 2010 Nov 1;38(9):746–50Suárez C, Peña C, Gavaldà L, Tubau F, Manzur A, Dominguez MA, et al. Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection. Int J Infect Dis. 2010 Sep 1;14(SUPPL. 3):e73–8.Pang Z, Raudonis R, Glick BR, Lin TJ, Cheng Z. Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and alternative therapeutic strategies. Biotechnol Adv. 2019 Jan 1;37(1):177–92.Mercado-Tobio Luisa Fernanda, Martínez Orfa Contreras, Angulo-Ortiz Alberto. EVALUACIÓN DE LA ACTIVIDAD ANTIBIOPELÍCULA DE LOS EXTRACTOS DE Trichilia hirta L. FRENTE AISLADOS CLÍNICOS DE Pseudomona aeruginosa EN MONTERÍACÓRDOBA [Internet]. Universidad de Córdoba. Facultad de Ciencias Básicas. Laboratorio de Productos Naturales. [Cordoba]: Universidad de cordoba; 2020 [cited 2021 Sep 5]. Available from: https://repositorio.unicordoba.edu.co/bitstream/handle/ucordoba/3569/MercadoTobioLuisa Fernanda-ContrerasMartínezOrfaInés-ÁnguloOrtízAlbertoAntonio.pdf?sequence=1&isAllo wed=yGaete ME, Valenzuela MP, Bachero AW, Vega CC, Marín NV, Labarca JL, et al. Carbapenemasas en Pseudomonas aeruginosa con susceptibilidad disminuida a los carbapenémicos después de una década, desde VIM a KPC. Rev Chil infectología [Internet]. 2020 Aug 1 [cited 2021 Sep 12];37(4):389–94. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182020000400389&lng= es&nrm=iso&tlng=esAsif M, Alvi IA, Ur Rehman S. Insight into acinetobacter baumannii: Pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities [Internet]. Vol. 11, Infection and Drug Resistance. Dove Press; 2018 [cited 2021 Aug 22]. p. 1249–60. Available from: /pmc/articles/PMC6110297/Ribeiro LF, Lopes EM, Kishi LT, Ribeiro LFC, Menegueti MG, Gaspar GG, et al. Microbial community profiling in intensive care units expose limitations in current sanitary standards. Front Public Heal. 2019;7(AUG):240Harding CM, Hennon SW, Feldman MF. Uncovering the mechanisms of Acinetobacter baumannii virulence [Internet]. Vol. 16, Nature Reviews Microbiology. NIH Public Access; 2018 [cited 2021 Aug 22]. p. 91–102. Available from: /pmc/articles/PMC6571207/Cendra M del M, Torrents E. Pseudomonas aeruginosa biofilms and their partners in crime. Biotechnol Adv. 2021 Jul 1;49:107734.Pujol M, Limón E. Epidemiología general de las infecciones nosocomiales. Sistemas y programas de vigilancia. Enferm Infecc Microbiol Clin [Internet]. 2013 Feb 1 [cited 2021 Aug 29];31(2):108–13. Available from: https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-artic ulo-epidemiologia-general-infecciones-nosocomiales-sistemas-S0213005X13000025Angeletti S, Cella E, Prosperi M, Spoto S, Fogolari M, De Florio L, et al. Multi-drug resistant Pseudomonas aeruginosa nosocomial strains: Molecular epidemiology and evolution. Microb Pathog. 2018 Oct 1;123:233–41.Llanos-Torres KH, Pérez-Orozco R, Málaga G. Infecciones nosocomiales en unidades de observación de emergencia y su asociación con el hacinamiento y la ventilación. Rev Peru Med Exp Salud Publica [Internet]. 2020 Oct 13 [cited 2021 Sep 13];37(4):721–5. Available from: https://rpmesp.ins.gob.pe/rpmesp/article/view/5192/4010Rosales C, Francesconi GV, Molina J, Listovsky G, Carvalho C, Kemper ES, et al. Sistema Integrado de Informações Mais Médicos: uma ferramenta de suporte à gestão baseada em evidências. Rev Panam Salud Pública. 2020;1–7.da Costa JST, Lima CA, Vera-Leiva A, San Martin Magdalena I, Bello-Toledo H, Domínguez Yévenes M, et al. Carbapenemasas en aislamientos de Pseudomonas aeruginosa resistentes a carbapenémicos aisladas en hospitales de Chile. Rev Chil infectología [Internet]. 2021 [cited 2022 Feb 14];38(1):81–7. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182021000100081&lng= es&nrm=iso&tlng=esKostyanev T, Xavier BB, García-Castillo M, Lammens C, Bravo-Ferrer Acosta J, Rodríguez-Baño J, et al. Phenotypic and molecular characterizations of carbapenem-resistant Acinetobacter baumannii isolates collected within the EURECA study. Int J Antimicrob Agents. 2021 Jun 1;57(6):106345.Nikibakhsh M, Firoozeh F, Badmasti F, Kabir K, Zibaei M. Molecular study of metallo-β-lactamases and integrons in Acinetobacter baumannii isolates from burn patients. BMC Infect Dis. 2021 Dec 1;21(1).Guner Ozenen G, Sahbudak Bal Z, Umit Z, Avcu G, Tekin D, Kurugol Z, et al. Nosocomial Non-fermentative gram negative bacteria bloodstream infections in children; Risk factors and clinical outcomes of carbapenem resistance. J Infect Chemother. 2021 May 1;27(5):729–35Yamani L, Alamri A, Alsultan A, Alfifi S, Ansari MA, Alnimr A. Inverse correlation between biofilm production efficiency and antimicrobial resistance in clinical isolates of Pseudomonas aeruginosa. Microb Pathog. 2021 Aug 1;157:104989.Ropponen HK, Richter R, Hirsch AKH, Lehr CM. Mastering the Gram-negative bacterial barrier – Chemical approaches to increase bacterial bioavailability of antibiotics. Adv Drug Deliv Rev. 2021 May 1;172:339–60.Chen J, Zhou R, Li Z, Li Q, Long Y, Wang H, et al. Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection. Int J Infect Dis. 2021 Feb 1;103:167–72Yadav SK, Bhujel R, Hamal P, Mishra SK, Sharma S, Sherchand JB. Burden of multidrug-resistant acinetobacter baumannii infection in hospitalized patients in a tertiary care hospital of Nepal. Infect Drug Resist [Internet]. 2020 [cited 2021 Aug 22];13:725–32. Available from: /pmc/articles/PMC7061726/Kurihara MNL, Sales RO de, Silva KE da, Maciel WG, Simionatto S. Multidrug-resistant Acinetobacter baumanniioutbreaks: a global problem in healthcare settings. Rev Soc Bras Med Trop [Internet]. 2020 [cited 2021 Aug 22];53:e20200248. Available from: /pmc/articles/PMC7670754/Rosales C, Francesconi GV, Molina J, Listovsky G, Carvalho C, Kemper ES, et al. Sistema Integrado de Informações Mais Médicos: uma ferramenta de suporte à gestão baseada em evidências. Rev Panam Salud Pública. 2020;1–7.da Costa JST, Lima CA, Vera-Leiva A, San Martin Magdalena I, Bello-Toledo H, Domínguez Yévenes M, et al. Carbapenemasas en aislamientos de Pseudomonas aeruginosa resistentes a carbapenémicos aisladas en hospitales de Chile. Rev Chil infectología [Internet]. 2021 [cited 2022 Feb 14];38(1):81–7. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182021000100081&lng= es&nrm=iso&tlng=esCipko K, Kizny Gordon A, Adhikari S, Konecny P. Cefiderocol treatment of Pseudomonas aeruginosa and extensively drug-resistant Acinetobacter baumannii retained spinal hardware infection causing reversible acute interstitial nephritis: Recto: Cefiderocol causing acute interstitial nephritis. Int J Infect Dis. 2021 Aug 1;109:108–11.Subedi D, Vijay AK, Willcox M. Overview of mechanisms of antibiotic resistance in Pseudomonas aeruginosa: an ocular perspective. https://doi.org/101111/cxo12621 [Internet]. 2021 Mar 1 [cited 2021 Sep 20];101(2):162–71. Available from: https://www.tandfonline.com/doi/abs/10.1111/cxo.12621Asenjo A, Oteo-Iglesias J, Alós J-I. What’s new in mechanisms of antibiotic resistance in bacteria of clinical origin? Enfermedades Infecc y Microbiol Clin (English ed). 2021 Jun 1;39(6):291–9.Rosales-Reyes R, Vargas-Roldán SY, Lezana-Fernández JL, Santos-Preciado JI. Pseudomonas Aeruginosa: Genetic Adaptation, A Strategy for its Persistence in Cystic Fibrosis. Arch Med Res. 2021 May 1;52(4):357–61Huang X, Li T, Zhang X, Deng J, Yin X. Bimetallic palladium@copper nanoparticles: Lethal effect on the gram-negative bacterium Pseudomonas aeruginosa. Mater Sci Eng C. 2021 Oct 1;129:112392.Bashir A, Brown JS. Pseudomonas aeruginosa. Ref Modul Biomed Sci [Internet]. 2021 Jan 1 [cited 2021 Sep 10]; Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780081027233002584Crémet L, Leroy AG, Muller D, Delanou S, Burghelea A, Broquet A, et al. Antibiotic resistance heterogeneity and LasR diversity within Pseudomonas aeruginosa populations from pneumonia in intensive care unit patients. Int J Antimicrob Agents. 2021 Jun 1;57(6):106341Li Y, Xia L, Chen J, Lian Y, Dandekar AA, Xu F, et al. Resistance elicited by sub-lethal concentrations of ampicillin is partially mediated by quorum sensing in Pseudomonas aeruginosa. Environ Int. 2021 Nov 1;156:106619.Khademi F, Maarofi K, Arzanlou M, Peeri-Dogaheh H, Sahebkar A. Which missense mutations associated with DNA gyrase and topoisomerase IV are involved in Pseudomonas aeruginosa clinical isolates resistance to ciprofloxacin in Ardabil? Gene Reports. 2021 Sep 1;24:101211.Abavisani M, Goudarzi M, Ghalavand Z, Hajikhani B, Rad ZR, Rad ZR, et al. Evaluation of efflux pumps overexpression and β-lactamase genes among colistin resistant Pseudomonas aeruginosa. Gene Reports. 2021 Sep 1;24:101301.Zahedi bialvaei A, Rahbar M, Hamidi-Farahani R, Asgari A, Esmailkhani A, Mardani dashti Y, et al. Expression of RND efflux pumps mediated antibiotic resistance in Pseudomonas aeruginosa clinical strains. Microb Pathog. 2021 Apr 1;153:104789.Tang B, Yang H, Jia X, Feng Y. Coexistence and characterization of Tet(X5) and NDM-3 in the MDR-Acinetobacter indicus of duck origin. Microb Pathog. 2021 Jan 1;150:104697.Snyman Y, Reuter S, Whitelaw AC, Stein L, Maloba MRB, Newton-Foot M. Characterisation of mcr-4.3 in a colistin-resistant Acinetobacter nosocomialis clinical isolate from Cape Town, South Africa. J Glob Antimicrob Resist. 2021 Jun 1;25:102–6Chen J, Zhou R, Li Z, Li Q, Long Y, Wang H, et al. Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection. Int J Infect Dis. 2021 Feb 1;103:167–72König P, Averhoff B, Müller V. K+ and its role in virulence of Acinetobacter baumannii. Int J Med Microbiol. 2021 Jul 1;311(5):151516.Li Y, Peng C, Zhao D, Liu L, Guo B, Shi M, et al. Outer membrane protein A inhibits the degradation of caspase-1 to regulate NLRP3 inflammasome activation and exacerbate the Acinetobacter baumannii pulmonary inflammation. Microb Pathog. 2021 Apr 1;153:104788.Hao M, Ma W, Dong X, Li X, Cheng F, Wang Y. Comparative genome analysis of multidrug-resistant Pseudomonas aeruginosa JNQH-PA57, a clinically isolated mucoid strain with comprehensive carbapenem resistance mechanisms. BMC Microbiol. 2021 Dec 1;21(1):1–16Mea HJ, Yong PVC, Wong EH. An overview of Acinetobacter baumannii pathogenesis: Motility, adherence and biofilm formation. Microbiol Res. 2021 Jun 1;247:126722.Kostyanev T, Xavier BB, García-Castillo M, Lammens C, Bravo-Ferrer Acosta J, Rodríguez-Baño J, et al. Phenotypic and molecular characterizations of carbapenem-resistant Acinetobacter baumannii isolates collected within the EURECA study. Int J Antimicrob Agents. 2021 Jun 1;57(6):106345.Elbehiry A, Marzouk E, Moussa IM, Dawoud TM, Mubarak AS, Al-Sarar D, et al. Acinetobacter baumannii as a community foodborne pathogen: Peptide mass fingerprinting analysis, genotypic of biofilm formation and phenotypic pattern of antimicrobial resistance. Saudi J Biol Sci. 2021 Jan 1;28(1):1158–66.Yamani L, Alamri A, Alsultan A, Alfifi S, Ansari MA, Alnimr A. Inverse correlation between biofilm production efficiency and antimicrobial resistance in clinical isolates of Pseudomonas aeruginosa. Microb Pathog. 2021 Aug 1;157:104989.Shan W, Zhang H, Kan J, Yin M, Zhang J, Wan L, et al. Acquired mucoid phenotype of Acinetobacter baumannii: Impact for the molecular characteristics and virulence. Microbiol Res. 2021 May 1;246:126702Bedenić B, Meštrović T. Mechanisms of resistance in gram-negative urinary pathogens: From country-specific molecular insights to global clinical relevance. Diagnostics. 2021;11(5).Nikibakhsh M, Firoozeh F, Badmasti F, Kabir K, Zibaei M. Molecular study of metallo-β-lactamases and integrons in Acinetobacter baumannii isolates from burn patients. BMC Infect Dis. 2021 Dec 1;21(1).Oliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244eOliva Menacho JE. Genes que expresan resistencia a carbapenemasas presentes en Pseudomona aeruginosa. Rev Peru Ciencias la Salud [Internet]. 2021 Jan 1 [cited 2021 Sep 10];3(1):e244–e244. Available from: http://revistas.udh.edu.pe/index.php/RPCS/article/view/244eEdwards F, MacGowan A, Macnaughton E. Antibiotic resistance [Internet]. Vol. 49, Medicine (United Kingdom). Elsevier; 2021 [cited 2021 Sep 5]. p. 1–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1357303921001985Henderson A, Bursle E, Stewart A, Harris PNA, Paterson D, Chatfield MD, et al. A systematic review of antimicrobial susceptibility testing as a tool in clinical trials assessing antimicrobials against infections due to gram-negative pathogens. Clinical Microbiology and Infection. Elsevier; 2021Guner Ozenen G, Sahbudak Bal Z, Umit Z, Avcu G, Tekin D, Kurugol Z, et al. Nosocomial Non-fermentative gram negative bacteria bloodstream infections in children; Risk factors and clinical outcomes of carbapenem resistance. J Infect Chemother. 2021 May 1;27(5):729–35Freire MP, Song ATW, Oshiro ICV, Andraus W, D’Albuquerque LAC, Abdala E. Surgical site infection after liver transplantation in the era of multidrug-resistant bacteria: what new risks should be considered? Diagn Microbiol Infect Dis. 2021 Jan 1;99(1):115220.Bayraktar M, Kaya E, Ozturk A, İbahim BMS. Antimicrobial susceptibility of bacterial pathogens isolated from healthcare workers’ cellphones. Infect Dis Now. 2021 Jun 4Ropponen HK, Richter R, Hirsch AKH, Lehr CM. Mastering the Gram-negative bacterial barrier – Chemical approaches to increase bacterial bioavailability of antibiotics. Adv Drug Deliv Rev. 2021 May 1;172:339–60Pandit P, Sahni AK, Grover N, Dudhat V, Das NK, Biswas AK. Catheter-related blood stream infections: prevalence, risk factors and antimicrobial resistance pattern. Med J Armed Forces India. 2021 Jan 1;77(1):38–45.Alharbi NM, Ziadi MM. Wastewater as a fertility source for novel bacteriophages against multi-drug resistant bacteria. Vol. 28, Saudi Journal of Biological Sciences. Elsevier; 2021. p. 4358–64.Herbert R, Curtis C. Commonly encountered central nervous system infections in the neurointensive care unit. Anaesth Intensive Care Med. 2021 Feb 1;22(2):89–94.Saidin S, Jumat MA, Mohd Amin NAA, Saleh Al-Hammadi AS. Organic and inorganic antibacterial approaches in combating bacterial infection for biomedical application. Mater Sci Eng C. 2021 Jan 1;118:111382.Sambrano H, Castillo JC, Ramos CW, de Mayorga B, Chen O, Durán O, et al. Prevalence of antibiotic resistance and virulent factors in nosocomial clinical isolates of Pseudomonas aeruginosa from Panamá. Brazilian J Infect Dis. 2021 Jan 1;25(1):101038.Gouveia e Melo R, Martins B, Pedro DM, Santos CM, Duarte A, Fernandes e Fernandes R, et al. Microbial evolution of vascular graft infections in a tertiary hospital based on positive graft cultures. J Vasc Surg. 2021 Jul 1;74(1):276-284.e4.Aboelenin AM, Hassan R, Abdelmegeed ES. The effect of EDTA in combination with some antibiotics against clinical isolates of gram negative bacteria in Mansoura, Egypt. Microb Pathog. 2021 May 1;154:104840.Saharman YR, Karuniawati A, Sedono R, Aditianingsih D, Qi H, Verbrugh HA, et al. Multimodal intervention to reduce acquisition of carbapenem-non-susceptible Gram-negative bacteria in intensive care units in the National Referral Hospital of Indonesia: An interrupted time series study. J Crit Care. 2021 Aug 1;64:237–44Cantón R, Huarte R, Morata L, Trillo-Mata JL, Muñoz R, González J, et al. Determining the burden of infectious diseases caused by carbapenem-resistant gram-negative bacteria in Spain. Enfermedades Infecc y Microbiol Clin (English ed). 2021 Apr 1;39(4):179–83.Almangour TA, Alruwaili A, Almutairi R, Alrasheed A, Alhifany AA, Eljaaly K, et al. Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study. Int J Infect Dis. 2021 Jul 1;108:406–12Miltgen G, Bour M, Allyn J, Allou N, Vedani T, Vuillemenot J-B, et al. Molecular and epidemiological investigation of a colistin-resistant OXA-23/NDM-1-producing Acinetobacter baumannii outbreak in Southwest Indian Ocean. Int J Antimicrob Agents [Internet]. 2021 Jul 19 [cited 2021 Jul 29];106402. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0924857921001679Cendra M del M, Torrents E. Pseudomonas aeruginosa biofilms and their partners in crime. Biotechnol Adv. 2021 Jul 1;49:107734Jackson L, Waters V. Factors influencing the acquisition and eradication of early Pseudomonas aeruginosa infection in cystic fibrosis. J Cyst Fibros. 2021 Jan 1;20(1):8–16.Santos Rosado Castro M, da Silva Fernandes M, Kabuki DY, Kuaye AY. Modelling Pseudomonas fluorescens and Pseudomonas aeruginosa biofilm formation on stainless steel surfaces and controlling through sanitisers. Int Dairy J. 2021 Mar 1;114:104945.Santos Rosado Castro M, da Silva Fernandes M, Kabuki DY, Kuaye AY. Modelling Pseudomonas fluorescens and Pseudomonas aeruginosa biofilm formation on stainless steel surfaces and controlling through sanitisers. Int Dairy J. 2021 Mar 1;114:104945.Hosseinkhan N, Allahverdi A, Abdolmaleki F. The novel potential multidrug-resistance biomarkers for Pseudomonas aeruginosa lung infections using transcriptomics data analysis. Informatics Med Unlocked. 2021 Jan 1;22:100509.McAulay K, Schuetz AN, Fauntleroy K, Shen L, Merveille YM, Deroncelay A, et al. Multidrug-resistant Pseudomonas aeruginosa in healthcare facilities in Port-au-Prince, Haiti. J Glob Antimicrob Resist. 2021 Jun 1;25:60–5Abozahra R, El-Kholy MA, Baraka K. Virulence genotyping of drug resistant Pseudomonas aeruginosa clinical isolates in Egypt using multiplex PCR. Gene Reports. 2021 Mar 1;22:101000Rad ZR, Rad ZR, Goudarzi H, Goudarzi M, Alizade H, Hematian A, et al. Detection of New Delhi Metallo-β-lactamase-1 among Pseudomonas aeruginosa isolated from adult and Pediatric patients in Iranian hospitals. Gene Reports. 2021 Jun 1;23:101152.Tchakal-Mesbahi A, Metref M, Singh VK, Almpani M, Rahme LG. Characterization of antibiotic resistance profiles in Pseudomonas aeruginosa isolates from burn patients. Burns [Internet]. 2021 Mar 17 [cited 2021 Jul 29];12(1):15–22. Available from: https://www.mendeley.com/catalogue/563c3a31-1ae2-3f1c-b5b6-0be19bbc70a6/?utm_sour ce=desktop&utm_medium=1.19.8&utm_campaign=open_catalog&userDocumentId=%7Bc a78cba7-035a-3cca-86db-be52f38cd985%7DMkwata HM, Omoregie AI, Nissom PM. Lytic bacteriophages isolated from limestone caves for biocontrol of Pseudomonas aeruginosa. Biocatal Agric Biotechnol. 2021 Jul 1;34:102011.Ali KM, Al-Jaff BMA. Source and antibiotic susceptibility of gram-negative bacteria causing superficial incisional surgical site infections. Int J Surg Open. 2021 Mar 1;30:100318.Lim WY, Tan GSE, Htun HL, Phua HP, Kyaw WM, Guo H, et al. First nosocomial cluster of COVID-19 due to the Delta variant in a major acute care hospital in Singapore: investigations and outbreak response. J Hosp Infect. 2022 Apr 1;122:27–34Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs Context [Internet]. 2018 [cited 2022 Mar 31];7:212527. Available from: /pmc/articles/PMC5978525/Almangour TA, Alruwaili A, Almutairi R, Alrasheed A, Alhifany AA, Eljaaly K, et al. Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study. Int J Infect Dis. 2021 Jul 1;108:406–12.CLSIInfecciones nosocomialesMultirresistenciaPseudomonas aeruginosaAcinetobacter baumanniiLICENSElicense.txtlicense.txttext/plain; charset=utf-814828https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/5/license.txt2f9959eaf5b71fae44bbf9ec84150c7aMD55open accessTEXTEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdf.txtEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdf.txtExtracted texttext/plain95757https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/6/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf.txta7758c7df0fdc1cf66286a99113fc431MD56open accessPresentacion sustentación Miguel Angel Sanchez Porras.pdf.txtPresentacion sustentación Miguel Angel Sanchez Porras.pdf.txtExtracted texttext/plain9089https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/8/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf.txt47c17ba8c58018746a74fdfdb56430c1MD58open accessCARTA DERECHOS DE AUTOR Sanchez.pdf.txtCARTA DERECHOS DE AUTOR Sanchez.pdf.txtExtracted texttext/plain1139https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/10/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdf.txt985053829f1d56185969e76a23459c63MD510metadata only accessFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdf.txtFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdf.txtExtracted texttext/plain2898https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/12/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf.txt450c6d00976d55bce98b0dae1cc3b158MD512metadata only accessTHUMBNAILEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdf.jpgEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdf.jpgGenerated Thumbnailimage/jpeg5474https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/7/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf.jpg58459015af4d1096f94ca72ac5ae5284MD57open accessPresentacion sustentación Miguel Angel Sanchez Porras.pdf.jpgPresentacion sustentación Miguel Angel Sanchez Porras.pdf.jpgGenerated Thumbnailimage/jpeg8722https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/9/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf.jpg5e49c21f279377c8cc572e867f0c6e7dMD59open accessCARTA DERECHOS DE AUTOR Sanchez.pdf.jpgCARTA DERECHOS DE AUTOR Sanchez.pdf.jpgGenerated Thumbnailimage/jpeg9397https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/11/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdf.jpgcfda89e18dafff84a1340089e0f9e5b7MD511metadata only accessFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdf.jpgFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdf.jpgGenerated Thumbnailimage/jpeg11603https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/13/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf.jpg30d575425086823d3713b92d98243a96MD513metadata only accessORIGINALEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdfEstudio de los mecanismos de resistencia de los principales microorganismos Gram negativos no fermentadores asociados a infecciones nosocomiales .pdfapplication/pdf3071441https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/1/Estudio%20de%20los%20mecanismos%20de%20resistencia%20de%20los%20principales%20microorganismos%20Gram%20negativos%20no%20fermentadores%20asociados%20a%20infecciones%20nosocomiales%20%20.pdf5f35bf303cb509976311d4520cc95985MD51open accessPresentacion sustentación Miguel Angel Sanchez Porras.pdfPresentacion sustentación Miguel Angel Sanchez Porras.pdfapplication/pdf1554218https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/2/Presentacion%20sustentaci%c3%b3n%20Miguel%20Angel%20Sanchez%20Porras.pdf3553f79c326c0156f11a366984d4b409MD52open accessCARTA DERECHOS DE AUTOR Sanchez.pdfCARTA DERECHOS DE AUTOR Sanchez.pdfapplication/pdf153768https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/3/CARTA%20DERECHOS%20DE%20AUTOR%20Sanchez.pdfd55b5a7dcb291af36f3e91fda054ee06MD53metadata only accessFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdfFORMATO IDENTIFICACIÓN TRABAJOS DE GRADO.pdfapplication/pdf153426https://repositorio.unicolmayor.edu.co/bitstream/unicolmayor/5676/4/FORMATO%20IDENTIFICACI%c3%93N%20TRABAJOS%20DE%20GRADO.pdf0396286ce8d6bfb8b25b2f6a581f5905MD54metadata only accessunicolmayor/5676oai:repositorio.unicolmayor.edu.co:unicolmayor/56762024-05-09 14:13:23.253An error occurred on the license name.|||https://creativecommons.org/licenses/by-nc-sa/4.0/open accessBiblioteca Digital Unicolmayorrepositorio@unicolmayor.edu.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