Vol. 13. Núm. 51.
Páginas 2972-2980 (Marzo 2022)

Infecciones por microorganismos del grupo HACEK y otros bacilos gramnegativos infrecuentes

Infections due to microorganisms of the HACEK group and other uncommon Gram-negative bacilli

J. Calderón-ParraabcA. Callejas DíazabcA. Muñoz Serranoabc
Doi : https://10.1016/j.med.2022.03.002
Opciones
Resumen

Existen multitud de bacilos gramnegativos (BGN) infrecuentes capaces de causar distintas infecciones en el ser humano, siendo un grupo de patógenos extremadamente heterogéneo. Destacan los conocidos como BGN del grupo HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella y Kingella), bacterias de lento crecimiento que constituyen una causa infrecuente de endocarditis infecciosa de curso subagudo con complicaciones embólicas. La mayoría son flora oral, provocando infección tras intervenciones dentales. Las nuevas técnicas microbiológicas, como mejores medios de cultivo, el MALDI-TOFF o técnicas moleculares como secuenciación de ADN o el empleo de PCR para ARNr 16S han supuesto un avance en su diagnóstico. Su tratamiento es variable, soliéndose emplear amoxicilina-clavulánico o cefalosporinas de tercera generación. De los BGN infrecuentes no HACEK, la mayoría son bacterias ubicuas que contaminan aguas y superficies hospitalarias, dando lugar a infecciones en brotes nosoco-miales, incluyendo neumonías, bacteriemias por catéter y otras infecciones por dispositivos. Destacan los géneros Achromobacter, Alcaligenes, Chryseobacterium y Elizabethkingia. Algunos géneros, como Actinobacillus, Aeromonas o Chromobacterium pueden dar lugar a infecciones tras la exposición a aguas insalubres. Capnocytophaga y Pasteurella pueden producir infecciones tras mordeduras por animales. Su tratamiento es variable y suele basarse en betalactámicos con inhibidores de betalactamasa.

Palabras clave
Bacilos gramnegativos
Grupo HACEK
Endocarditis infecciosa
Infecciones nosocomiales
Abstract

There are a multitude of uncommon Gram-negative bacilli (GNB) capable of causing various infections in human beings; it is an extremely heterogeneous group of pathogens. Of note are those known as HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella) group GNB. They are slow-growing bacteria that are an infrequent cause of infective endocarditis with a subacute course and embolic complications. The majority are oral flora, causing infection following dental procedures. New microbiological techniques such as better culture media, MALDI-TOF, or molecular techniques such as DNA sequencing or the use of 16S rRNA PCR represent advances in their diagnosis. Treatment for them varies; amoxicillin-clavulanic acid or third-generation cephalosporins tend to be used. Of the uncommon non-HACEK GNB, the majority are ubiquitous bacteria that contaminate water and hospital surfaces, giving rise to nosocomial outbreaks of infections, including pneumonias, catheter-associated bacteremias, and other device-related infections. Of note are the genera Achromobacter, Alcaligenes, Chryseobacterium, and Elizabethkingia. Some genera, such as Actinobacillus, Aeromonas, or Chromobacterium, can give rise to infections following exposure to dirty water. Capnocytophaga and Pasteurella can produce infections following animal bites. Their treatment varies and tends to be based on beta-lactams with beta-lactamase inhibitors.

Keywords
Gram-negative bacilli
HACEK group
Infective endocarditis
Nosocomial infections

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