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Suscetibilidade aos antibióticos em isolados de urocultura num hospital privado de Lisboa
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A infeção do trato urinário (ITU) é a infeção mais frequente no meio hospitalar e a segunda em doentes em regime de ambulatório, logo a seguir ao foco respiratório. Com o objetivo de conhecer os agentes etiológicos mais comuns na infeção urinária, o seu padrão de suscetibilidade aos antibióticos e inferir a epidemiologia de Enterobacteriales produtores de beta-lactamases de espectro alargado (ESBL) causadores deste tipo de infeções, foram analisadas todas as uroculturas que deram entrada no Serviço de Patologia Clínica do Hospital da Luz Lisboa, no período entre janeiro a agosto de 2022. Foram consideradas 15362 uroculturas. Destas, 3467 foram positivas. Escherichia coli foi o microrganismo mais isolado (67,5%), seguido por Klebsiella pneumoniae (8,6%). Em relação à suscetibilidade aos antibióticos, verificamos que os Enterobacteriales apresentam elevada resistência à amoxicilina e amoxicilina/ácido clavulânico. Para estes, os grupos de antibióticos com maior taxa de suscetibilidade foram os carbapenemos, cefalosporinas e aminoglicosídeos. Do total de E. coli isoladas, 4,7% revelaram-se positivas para a presença de ESBL, assim como 14,7% do total de K. pneumoniae. Os carbapenemos, a fosfomicina e a nitrofurantoína foram os antibióticos com as taxas de suscetibilidade mais elevadas em E. coli produtora de ESBL, já o cotrimoxazol e ciprofloxacina foram aqueles a que esta bactéria teve maior resistência. As menores taxas de suscetibilidade em K. pneumoniae produtora de ESBL observaram-se na amoxicilina ácido clavulânico, na piperacilina-tazobactam, no cotrimoxazol e na ciprofloxacina. Este estudo permite dispor de dados necessários para o conhecimento dos diferentes agentes etiológicos mais importantes nas ITU, do panorama de disseminação de bactérias produtoras de ESBL entre a comunidade servida por este hospital e disponibilizar informação sobre os seus padrões de resistências, necessários para se iniciar um tratamento empírico adequado, elaborar guias de tratamento e tomar medidas de controlo de infeção.
Urinary tract infection (UTI) is the most frequent infection in the hospital environment and the second in outpatients, just after the respiratory source. With the objective of knowing the most common etiological agents in urinary tract infections, their pattern of susceptibility to antibiotics and inferring the epidemiology of Enterobacteriales that produce ESBL and cause this type of infection, we analyse all the urine bacteriological exams from the Serviço de Patologia Clínica do Hospital da Luz Lisboa, during the period between January and August 2022. During this period, 15362 urine bacteriological exams were made. The cultural exam was positive in 3467 samples. Escherichia coli was the most identified microorganism (67.5%), followed by Klebsiella pneumoniae (8.6%). Concerning antimicrobial susceptibility, Enterobacteriales presented with a high resistance to amoxicillin and amoxicillin/clavulanic acid. For these bacteria, the groups of antibiotics with the highest susceptibility rate were carbapenems, cephalosporins and aminoglycosides. ESBL were found in 4.7% of all E. coli strains and 14.7% of K. pneumoniae. Carbapenems, fosfomycin and nitrofurantoin were the antibiotics with the highest susceptibility rates in E. coli that produced ESBL, while cotrimoxazole and ciprofloxacin were the ones to which this bacteria had the highest rate of resistance. The lowest susceptibility rates in ESBL-producing K. pneumoniae were observed for amoxicillin-clavulanic acid, piperacillin-tazobactam, cotrimoxazole and ciprofloxacin. This study provides vital data concerning the microbiological epidemiology of urinary tract infection agents, the dissemination panorama of ESBL-producing bacteria among the community served by this hospital and offers information on their resistance patterns, essential to start appropriate empirical treatment, to develop treatment guidelines, and to take infection control measures.
Urinary tract infection (UTI) is the most frequent infection in the hospital environment and the second in outpatients, just after the respiratory source. With the objective of knowing the most common etiological agents in urinary tract infections, their pattern of susceptibility to antibiotics and inferring the epidemiology of Enterobacteriales that produce ESBL and cause this type of infection, we analyse all the urine bacteriological exams from the Serviço de Patologia Clínica do Hospital da Luz Lisboa, during the period between January and August 2022. During this period, 15362 urine bacteriological exams were made. The cultural exam was positive in 3467 samples. Escherichia coli was the most identified microorganism (67.5%), followed by Klebsiella pneumoniae (8.6%). Concerning antimicrobial susceptibility, Enterobacteriales presented with a high resistance to amoxicillin and amoxicillin/clavulanic acid. For these bacteria, the groups of antibiotics with the highest susceptibility rate were carbapenems, cephalosporins and aminoglycosides. ESBL were found in 4.7% of all E. coli strains and 14.7% of K. pneumoniae. Carbapenems, fosfomycin and nitrofurantoin were the antibiotics with the highest susceptibility rates in E. coli that produced ESBL, while cotrimoxazole and ciprofloxacin were the ones to which this bacteria had the highest rate of resistance. The lowest susceptibility rates in ESBL-producing K. pneumoniae were observed for amoxicillin-clavulanic acid, piperacillin-tazobactam, cotrimoxazole and ciprofloxacin. This study provides vital data concerning the microbiological epidemiology of urinary tract infection agents, the dissemination panorama of ESBL-producing bacteria among the community served by this hospital and offers information on their resistance patterns, essential to start appropriate empirical treatment, to develop treatment guidelines, and to take infection control measures.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Infeção do trato urinário Suscetibilidade aos antibióticos Beta lactamases de espetro estendido Tratamento empírico Doenças transmissíveis