Publication: Aplicación de modelos econométricos para cuantificar la evolución de la resistencia a antibióticos en pacientes hospitalarios de Europa y su asociación con la legislación europea
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2018-11-16
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Universidad Complutense de Madrid
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Abstract
Las infecciones que tienen lugar en pacientes hospitalizados (infecciones nosocomiales) constituyen una seria amenaza para la salud humana, pues existen cuadros concomitantes y un sistema inmune debilitado que ponen en riesgo su recuperación. Los agentes causantes pueden ser ubicuos en la naturaleza o estar presentes de forma natural en el ser humano, pero en determinadas condiciones algunas cepas de estos microrganismos presentan una elevada patogenicidad. Normalmente acompafia a este carácter patógeno una extraordinaria capacidad adquirida de resistencia a los tratamientos antibióticos. Tres de los microorganismos más frecuentemente aislados como responsables de estos cuadros son Escherichia coli, Klebsiella pneumoniae y Pseudomonas aeruginosa. Por ello existen protocolos de prevención en los hospitales encargados de dificultar la selección, aparición y diseminación de estas cepas. Asimismo, se documentan los brotes aparecidos aislándose e identificándose el microorganismo causante, así como las resistencias. Para su determinación y cuantificación se emplean pruebas laboratoriales. De esta forma para cada hospital y territorio se puede disponer de estadísticas de resistencias referenciadas a un lapso de tiempo determinado. Esta tesis doctoral disefta un modelo estadístico permitiendo estudiar retrospectivamente la evolución de los patrones de resistencia de diferentes microorganismos responsables de infecciones nosocomiales en Europa, desde que su emergencia hizo necesario recoger datos hasta la actualidad. El modelo está basado en la información recogida en EARS-Net, la base de datos de resistencia a antibióticos en hospitales de mayor implantación en la Unión Europea. Los grupos de antibióticos aquí estudiados son carbapenemas, cefalosporinas de tercera generación (C3G) y fluoroquinolonas, todos ellos arsenal terapéutico reservados a condiciones donde no se ha observado una mejoría clínica con antibióticos de amplio espectro, infecciones complicadas o nosocomiales...
Infections taking place in hospitalised patients (nosocomial infections) constitute a grave threat for human health, as they happen in patients with concomitant symptoms, commonly a compromised immune system jeopardising their recover. Causal agents can be ubiquitous in nature or naturally present in human being, but under specific circumstances, sorne strains have an extraordinary high pathogenicity. Such a high pathogenicity is usually accompanied of an extraordinary acquired capacity of antibiotic therapy resistance. Three of the microorganisms more frequently isolated as responsible of these infections are Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Given this fact, prevention protocols have been set in hospitals to prevent from resistant strains appearance, selection and dissemination. Hence, if an outbreak arises the causing agent is isolated and identified as well as its antibiotic resistance pattem. There are plenty of laboratorial tests for its determination and quantification. Therefore, for each given hospital and territory is possible to collect antibiotic resistance data with reference to a given lapse oftime. This thesis aims to design a statistic model able to retrospectively assess antibiotic resistance pattems of the different microorganisms responsible for nosocomial infections in Europe, since data is available until current time. The model is based in the information compiled in EARS-Net, hospital antibiotic resistance database with the greatest coverage in EU. The class of antibiotics studied in this thesis are carbapenems, third generation cephalosporins and fluorquinolones. They constitute therapeutic arsenal restricted to conditions where clinical improvement has not been achieved with broad-spectrum antibiotics, complicated infections or nosocomial infections...
Infections taking place in hospitalised patients (nosocomial infections) constitute a grave threat for human health, as they happen in patients with concomitant symptoms, commonly a compromised immune system jeopardising their recover. Causal agents can be ubiquitous in nature or naturally present in human being, but under specific circumstances, sorne strains have an extraordinary high pathogenicity. Such a high pathogenicity is usually accompanied of an extraordinary acquired capacity of antibiotic therapy resistance. Three of the microorganisms more frequently isolated as responsible of these infections are Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Given this fact, prevention protocols have been set in hospitals to prevent from resistant strains appearance, selection and dissemination. Hence, if an outbreak arises the causing agent is isolated and identified as well as its antibiotic resistance pattem. There are plenty of laboratorial tests for its determination and quantification. Therefore, for each given hospital and territory is possible to collect antibiotic resistance data with reference to a given lapse oftime. This thesis aims to design a statistic model able to retrospectively assess antibiotic resistance pattems of the different microorganisms responsible for nosocomial infections in Europe, since data is available until current time. The model is based in the information compiled in EARS-Net, hospital antibiotic resistance database with the greatest coverage in EU. The class of antibiotics studied in this thesis are carbapenems, third generation cephalosporins and fluorquinolones. They constitute therapeutic arsenal restricted to conditions where clinical improvement has not been achieved with broad-spectrum antibiotics, complicated infections or nosocomial infections...
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Tesis de la Universidad Complutense de Madrid, Facultad de Veterinaria, Departamento de Sanidad Animal, leída el 11/09/2017