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Epidemiology and antibiotic resistance of bacterial isolates from a portuguese cystic fibrosis reference center
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A resistência aos antimicrobianos constitui uma das grandes ameaças à saúde global, dificultando o controlo de diversas infeções. Isto é importante no contexto da Fibrose Quística, em que as infeções respiratórias são um dos principais fatores de morbimortalidade.
Este estudo caraterizou a epidemiologia da Unidade de Fibrose Quística de Adultos do Hospital de Santa Maria entre os anos 2018 e 2022, atentando no isolamento de organismos multirresistentes e na ocorrência de infeções crónicas. Procurou-se ainda relacionar estes fatores com a terapêutica com ivacaftor-tezacaftor-elexacaftor.
Foram considerados os resultados de 1242 culturas, que redundaram em 1546 testes de sensibilidade aos antimicrobianos. Após eliminação de duplicados seguindo as orientações do Clinical and Laboratory Standards Institute, foram obtidos 516 isolados bacterianos únicos.
Staphylococcus aureus (43,99%) e Pseudomonas aeruginosa (28,29%) representaram a maioria dos isolamentos, sendo também estes os agentes que mais frequentemente condicionaram infeção crónica (S. aureus em 44,41% dos doentes por ano e P. aeruginosa em 26,55%). Verificou-se pelo menos um isolamento multirresistente em 30,85% dos doentes por ano, com P. aeruginosa a estabelecer-se como o agente que afetou a maior proporção de doentes (23,97%), seguida de MRSA (10,51%). Observou-se um decréscimo na proporção de doentes com isolamentos multirresistentes nos cinco anos de estudo, de 36,51% para 24,19% (r = - 0,963; p = 0,009). No grupo de doentes sob ivacaftor-tezacaftor-elexacaftor, 33,33% apresentaram uma redução no número de isolamentos a condicionar infeção crónica (comparado com 7,69% no grupo não tratado) e 7,69% apresentaram uma diminuição do número de isolamentos multirresistentes (comparado com 18,18% no grupo não tratado).
Conclui-se que deve ser mantida a estratégia de erradicação precoce da infeção por P. aeruginosa e a escolha individualizada da antibioterapia para o controlo das exacerbações com base nos isolamentos prévios do doente.
Antimicrobial resistance is one of the major threats to global health, hindering the control of various infections. This is significant in the context of Cystic Fibrosis, in which respiratory infections are one of the main factors associated with morbimortality. This study characterized the epidemiology of the CHULN Adult Cystic Fibrosis Unit between the years 2018 and 2022, focusing on the isolation of multidrug-resistant organisms and the occurrence of chronic infections. It was also sought to relate these factors to elexacaftor-tezacaftor-ivacaftor therapy. Results from 1242 cultures were considered, yielding 1546 antimicrobial susceptibility tests. After elimination of duplicates following the Clinical and Laboratory Standards Institute guidelines, 516 unique bacterial isolates were retained in the data. Staphylococcus aureus (43,99%) and Pseudomonas aeruginosa (28,29%) represented most isolates and were also the agents that more frequently caused chronic infection (S. aureus in 44,41% of patients per year and P. aeruginosa in 26,55%). At least one multidrug-resistant isolate was identified in 30,85% of patients each year, with P. aeruginosa establishing itself as the agent affecting a greater proportion of patients (23,97%), followed by MRSA (10,51%). A decrease in the proportion of patients with multidrug-resistant isolates was observed over the five years of the study, from 36,51% to 24,19% (r = - 0,963; p = 0,009). In the group of patients under elexacaftor-tezacaftor-ivacaftor, 33,33% showed a reduction in the number of isolates causing chronic infection (compared to 7,69% in the untreated group) and 7,69% exhibited a decrease in the number of multidrug-resistant isolates (compared to 18,18% in the untreated group). It is concluded that the strategy of early eradication of P. aeruginosa infection and the individualized choice of antibiotic therapy for the control of exacerbations based on previous cultural results from each patient should be maintained.
Antimicrobial resistance is one of the major threats to global health, hindering the control of various infections. This is significant in the context of Cystic Fibrosis, in which respiratory infections are one of the main factors associated with morbimortality. This study characterized the epidemiology of the CHULN Adult Cystic Fibrosis Unit between the years 2018 and 2022, focusing on the isolation of multidrug-resistant organisms and the occurrence of chronic infections. It was also sought to relate these factors to elexacaftor-tezacaftor-ivacaftor therapy. Results from 1242 cultures were considered, yielding 1546 antimicrobial susceptibility tests. After elimination of duplicates following the Clinical and Laboratory Standards Institute guidelines, 516 unique bacterial isolates were retained in the data. Staphylococcus aureus (43,99%) and Pseudomonas aeruginosa (28,29%) represented most isolates and were also the agents that more frequently caused chronic infection (S. aureus in 44,41% of patients per year and P. aeruginosa in 26,55%). At least one multidrug-resistant isolate was identified in 30,85% of patients each year, with P. aeruginosa establishing itself as the agent affecting a greater proportion of patients (23,97%), followed by MRSA (10,51%). A decrease in the proportion of patients with multidrug-resistant isolates was observed over the five years of the study, from 36,51% to 24,19% (r = - 0,963; p = 0,009). In the group of patients under elexacaftor-tezacaftor-ivacaftor, 33,33% showed a reduction in the number of isolates causing chronic infection (compared to 7,69% in the untreated group) and 7,69% exhibited a decrease in the number of multidrug-resistant isolates (compared to 18,18% in the untreated group). It is concluded that the strategy of early eradication of P. aeruginosa infection and the individualized choice of antibiotic therapy for the control of exacerbations based on previous cultural results from each patient should be maintained.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Epidemiologia Fibrose quística Multirresistência antimicrobiana Ivacaftor Tezacafto Elexacaftor Infeção crónica Doenças transmissíveis