Infeções hospitalares por Enterobacteriaceae resistentes a Carbapenemos
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2019-01-31
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A resistência bacteriana a antibióticos é um problema cada vez mais recorrente em ambiente hospitalar, constatando-se um aumento considerável das resistências aos antibióticos por parte dos membros da família Enterobacteriaceae. As KPCs (Klebsiella pneumoniae carbapenemases) são enzimas que se encontram em algumas estirpes bacterianas multirresistentes e de difícil inativação. Isto deve-se ao facto de conferirem resistência a cefamicinas, penicilinas, cefalosporinas e não serem inibidas de uma forma eficiente por inibidores de β-lactamases. O presente estudo tem como objetivos: (i) determinar a frequência de bacilos gram negativos pertencentes à família Enterobacteriaceae, isolados em amostras clínicas hospitalares e comunitárias, e; (ii) analisar o perfil de suscetibilidade aos antibióticos dos isolados e o tratamento administrado aos pacientes. Foram incluídas neste trabalho um total de 339 estirpes bacterianas, recolhidas durante um período de 48 meses (janeiro de 2014 a dezembro de 2017), das quais 338 pertencentes à família Enterobacteriaceae, identificadas a nível de espécie como: Klebsiella pneumoniae (304), Escherichia coli (19), Moraganella morganni (5), Enterobacter cloacae (4), Citrobacter freundii (2), Klebsiella oxytoca (1), Klebsiella ozaenae (2) e Serratia mascescens (1), e uma estirpe não Enterobactereaceae identificada como Pseudomonas aeruginosa. Após a identificação, procedeu-se: (i) à avaliação dos perfis de suscetibilidade aos antibióticos das 304 estirpes de Klebsiella pneumoniae; (ii) à avaliação dos antibióticos mais administrados aos pacientes em que estas estirpes tinham sido isoladas; (iii) à caracterização da população dos pacientes quanto à idade e sexo (iv) e à avaliação do número de óbitos ocorridos. Da análise dos resultados foi possível determinar um grupo de risco na faixa etária dos 70 aos 89 anos transversal ao sexo, avaliar o perfil de suscetibilidade aos antibióticos e determinar que as estirpes de Klebsiella pneumoniae são resistentes à grande maioria dos antibióticos testados. Identificou-se a existência de um possível foco de infeção hospitalar, pois a grande maioria dos casos apresentam uma grande probabilidade de terem sido contraídos em ambiente hospitalar e a ocorrência de óbito em cerca de 42% dos pacientes internados.
Bacterial resistance to antibiotics is an increasingly recurrent problem in the hospital environment, with a considerable increase in resistance to antibiotics by members of the Enterobacteriaceae family. KPCs (Klebsiella pneumoniae carbapenemases) are enzymes found in some multiresistant, difficult-to-inactivate bacterial strains. This is because they confer resistance to cephamycins, penicillins, cephalosporins and are not efficiently inhibited by βlactamase inhibitors. The present study aims to: (i) determine the frequency of gram-negative bacilli belonging to the family Enterobacteriaceae, isolated in hospital and community clinical samples; (ii) to analyze the susceptibility profile to the antibiotics of the isolates and the treatment administered to the patients. A total of 339 bacterial strains collected during a period of 48 months (January 2014 to December 2017) were included in this study, of which 338 belonged to the Enterobacteriaceae family, identified as Klebsiella pneumoniae (304), Escherichia coli (19), Moraganella morganni (5), Enterobacter cloacae (4), Citrobacter freundii (2), Klebsiella oxytoca (1), Klebsiella ozaenae (2) and Serratia mascescens (1), and a non-Enterobactereaceae strain identified as Pseudomonas aeruginosa. After identification, we proceeded: (i) to evaluate the antibiotic susceptibility profiles of the 304 strains of Klebsiella pneumoniae; (ii) the evaluation of the most commonly administered antibiotics to the patients in whom these strains had been isolated; (iii) characterization of patients' population regarding age and sex (iv) and evaluation of the number of deaths. From the analysis of the results it was possible to determine a risk group in the age group from 70 to 89 years old cross-gender, to evaluate the susceptibility profile to antibiotics and to determine that strains of Klebsiella pneumoniae are resistant to the great majority of the antibiotics tested. It was identified the existence of a possible focus of hospital infection, since the great majority of the cases present a high probability of having been contracted in hospital environment and the occurrence of death in about 42% of hospitalized patients.
Bacterial resistance to antibiotics is an increasingly recurrent problem in the hospital environment, with a considerable increase in resistance to antibiotics by members of the Enterobacteriaceae family. KPCs (Klebsiella pneumoniae carbapenemases) are enzymes found in some multiresistant, difficult-to-inactivate bacterial strains. This is because they confer resistance to cephamycins, penicillins, cephalosporins and are not efficiently inhibited by βlactamase inhibitors. The present study aims to: (i) determine the frequency of gram-negative bacilli belonging to the family Enterobacteriaceae, isolated in hospital and community clinical samples; (ii) to analyze the susceptibility profile to the antibiotics of the isolates and the treatment administered to the patients. A total of 339 bacterial strains collected during a period of 48 months (January 2014 to December 2017) were included in this study, of which 338 belonged to the Enterobacteriaceae family, identified as Klebsiella pneumoniae (304), Escherichia coli (19), Moraganella morganni (5), Enterobacter cloacae (4), Citrobacter freundii (2), Klebsiella oxytoca (1), Klebsiella ozaenae (2) and Serratia mascescens (1), and a non-Enterobactereaceae strain identified as Pseudomonas aeruginosa. After identification, we proceeded: (i) to evaluate the antibiotic susceptibility profiles of the 304 strains of Klebsiella pneumoniae; (ii) the evaluation of the most commonly administered antibiotics to the patients in whom these strains had been isolated; (iii) characterization of patients' population regarding age and sex (iv) and evaluation of the number of deaths. From the analysis of the results it was possible to determine a risk group in the age group from 70 to 89 years old cross-gender, to evaluate the susceptibility profile to antibiotics and to determine that strains of Klebsiella pneumoniae are resistant to the great majority of the antibiotics tested. It was identified the existence of a possible focus of hospital infection, since the great majority of the cases present a high probability of having been contracted in hospital environment and the occurrence of death in about 42% of hospitalized patients.
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Relatório de Estágio do Mestrado em Biologia Clínica Laboratorial apresentado à Universidade de Trás-os-Montes e Alto Douro
Palavras-chave
Klebsiella pneumoniae , antibióticos , KPCs