Tuesday, 30 March 2021 09:20

Controlar el intercambio de información genética es clave para frenar la diseminación intrahospitalaria de resistencias a antibióticos

Placa de cultivo con diferentes cepas bacterianas Placa de cultivo con diferentes cepas bacterianas Álvaro San Millán, CNB-CSIC
  • Las poblaciones de bacterias entéricas tienen una gran capacidad de transmitir moléculas de ADN extra-cromosómico (plásmidos) con genes de resistencia a antibióticos de último recurso, utilizados en el ámbito hospitalario
  • Estas resistencias se extienden en la microbiota de pacientes hospitalizados, lo que puede afectar a largo plazo a la diseminación de resistencias a nivel global, poniendo en peligro la salud pública
  • Investigadores del CNB-CSIC y el IRYCIS proponen nuevos mecanismos de control específicos para frenar su expansión

El nuevo trabajo del grupo de Álvaro San Millán, investigador del Consejo Superior de Investigaciones Científicas (CSIC) en el Centro Nacional de Biotecnología (CNB-CSIC), en colaboración con el Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) y la Universidad de Oxford ha realizado la caracterización epidemiológica y genética de las bacterias intrahospitalarias que transmiten nuevas resistencias frente a antibióticos.

La propagación de los mecanismos de resistencia a antibióticos de mayor relevancia clínica entre patógenos bacterianos se debe fundamentalmente al intercambio de información genética extracromosómica entre bacterias. Estas moléculas de ADN, llamadas plásmidos, se multiplican de manera autónoma y se transmiten de forma independiente del ADN cromosómico. Los resultados de esta investigación publicada en Nature Microbiology apuntan a la importancia de los plásmidos en la diseminación de mecanismos y genes de resistencia a antibióticos de nueva generación que se utilizan en entornos hospitalarios entre las enterobacterias. Estas infecciones constituyen una de las principales amenazas para los pacientes hospitalizados, especialmente en las unidades de cuidados intensivos (UCIs), donde los pacientes ancianos e inmunodeprimidos son sometidos a procedimientos invasivos, que facilitan la colonización bacteriana.

San Millán destaca que “en estudios previos se ha demostrado que las bacterias portadoras de plásmidos de resistencia son capaces de formar reservorios en los ambientes hospitalarios y transmitirse a la microbiota intestinal de pacientes hospitalizados. La novedad de este estudio es que demuestra que  “una vez estas bacterias portadoras del plásmido de resistencia colonizan el intestino de un paciente, este plásmido se transfiere con alta frecuencia a otras bacterias residentes en la microbiota intestinal de este paciente y produciéndose una colonización  a largo plazo”. Aunque la bacteria productora de la colonización inicial desaparezca, las bacterias que han adquirido este plásmido pueden permanecer en la microbiota durante meses o incluso años.

Ricardo León-Sampedro, investigador del IRYCIS y el Hospital Ramón y Cajal recalca “los riesgos de esta colonización de larga duración, tanto a nivel individual, ya que puede producir el fracaso de tratamientos antibióticos en el paciente, como general, ya que promueve el mantenimiento y potencial diseminación del mecanismo de resistencia hacia otros pacientes o miembros de la comunidad.”  Javier de la Fuente, otro de los investigadores responsables del trabajo cree que “nuestro estudio apunta a la necesidad del desarrollo de nuevas terapias capaces de impedir la diseminación horizontal de plásmidos de resistencia a antibióticos y de descontaminar selectivamente la microbiota intestinal de los pacientes de cepas portadoras de estos plásmidos de gran relevancia clínica”.

Más información

Pervasive transmission of a carbapenem resistance plasmid in the gut microbe of hospitalized patients. León-Sampedro R, de la Fuente J, Díaz-Agero C, Crellen T, Musicha P, Rodríguez-Beltrán J, de la Vega C, Hernandez-García M, r-GNOSIS WP5 study group, López-Fresneña N, Ruiz-Garbajossa P, Cantón R, Coper BS, San Millan A. Nature Microbiology 2021 DOI: 10.1038/s41564-021-00879-y

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