<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022023000200055</article-id>
<article-id pub-id-type="doi">10.51481/amc.v65i2.1272</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Mecanismos de resistencia a la colistina, la nitrofurantoína y la fosfomicina en Enterobacterales]]></article-title>
<article-title xml:lang="en"><![CDATA[Mechanisms of resistance to colistin, nitrofurantoin and fosfomycin in Enterobacteriaceae]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Carballo]]></surname>
<given-names><![CDATA[Gian Carlo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Marín]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Caja Costarricense de Seguro Social Hospital Dr. Rafael Ángel Calderón Guardia Laboratorio Clínico]]></institution>
<addr-line><![CDATA[ San José]]></addr-line>
<country>Costa Rica</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Caja Costarricense de Seguro Social Hospital Dr. Rafael Ángel Calderón Guardia Laboratorio Clínico]]></institution>
<addr-line><![CDATA[ San José]]></addr-line>
<country>Costa Rica</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<volume>65</volume>
<numero>2</numero>
<fpage>55</fpage>
<lpage>64</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022023000200055&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022023000200055&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022023000200055&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Las enterobacterias son un grupo amplio y heterogéneo de bacilos Gram negativos que se aíslan de forma rutinaria en el laboratorio clínico y se asocian a una gran cantidad de cuadros clínicos. Aquellas resistentes a antibióticos de última línea, como a los carbapenémicos, representan un gran reto en los centros de salud. Ante la dificultad para tratar infecciones causadas por este tipo de bacterias, se ha retomado el uso de antimicrobianos clásicos como la colistina, la nitrofurantoína y la fosfomicina. El objetivo de este trabajo es detallar los principales mecanismos de resistencia para estos tres fármacos descritos en enterobacterias. Para ello, se efectuó una revisión bibliográfica de artículos científicos publicados entre los años 1999 y 2022, utilizando las bases de datos PubMed (NCBI), PLOS, Redalyc, Google Scholar y Science Direct. En este proceso, se usaron las palabras clave &#8220;Carbapenem-Resistant Enterobacteriaceae&#8221;, &#8220;colistin&#8221;, nitrofurantoin&#8221;, &#8220;fosfomycin&#8221;, &#8220;resistance&#8221; y &#8220;plasmids&#8221;. Se encontró que los mecanismos de resistencia son variados y abarcan fenómenos como modificación del sitio blanco, inactivación enzimática, impermeabilidad y eflujo. Además, los determinantes genéticos de resistencia se encuentran en cromosomas o en plásmidos. Conocer este tipo de información permite mejorar la vigilancia basada en el laboratorio, combatir el problema de resistencia a los antimicrobianos y optimizar el uso de estos antibióticos que forman parte del escaso arsenal para el tratamiento de ciertas infecciones causadas por microorganismos multidrogorresistentes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Enterobacteriaceae is a large and heterogeneous group of Gram-negative bacilli that are routinely isolated in the clinical laboratory and are associated with a large number of clinical conditions. Those resistant to last-line antibiotics, such as carbapenems, represent a great challenge in health-care centers. Given the difficulty in treating this type of infections, the use of old drugs such as colistin, nitrofurantoin and fosfomycin has been studied. The objective of this work is to detail the main resistance mechanisms described in Enterobacteriaceae for these three antibiotics. To do this, a survey of scientific articles from the years 1999 to 2022 was carried out using databases such as PubMed (NCBI), Google Scholar, PLOS, Redalyc and Science Direct. In this process, keywords &#8220;Carbapenem- Resistant Enterobacteriaceae&#8221;, &#8220;colistin&#8221;, nitrofurantoin&#8221;, &#8220;fosfomycin&#8221;, &#8220;resistance&#8221; and &#8220;plasmids&#8221; were used. Resistance mechanisms were found to be varied and involve phenomena such as target site modification, enzyme inactivation, impermeability, and efflux. In addition, the genetic determinants of resistance are found at the chromosomal level or in plasmids. Knowing this type of information makes it possible to improve laboratory-based surveillance, fight the problem of resistance to antibiotics and take care of these antibiotics, which are part of the scarce arsenal for the treatment of certain infections caused by multidrug-resistant microorganisms.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Enterobacteriaceae resistentes a los carbapenémicos]]></kwd>
<kwd lng="es"><![CDATA[colistina]]></kwd>
<kwd lng="es"><![CDATA[nitrofurantoína]]></kwd>
<kwd lng="es"><![CDATA[fosfomicina]]></kwd>
<kwd lng="es"><![CDATA[plásmidos]]></kwd>
<kwd lng="en"><![CDATA[Carbapenem-resistant Enterobacteriaceae]]></kwd>
<kwd lng="en"><![CDATA[colistin]]></kwd>
<kwd lng="en"><![CDATA[nitrofurantoin]]></kwd>
<kwd lng="en"><![CDATA[fosfomycin]]></kwd>
<kwd lng="en"><![CDATA[plasmids]]></kwd>
</kwd-group>
</article-meta>
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