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Caracterização epidemiológica da resistência de bactérias Gram positivo a Vancomicina, Linezolida e Daptomicina no CHULN
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Orientador(es)
Resumo(s)
A resistência à terapêutica antimicrobiana tornou-se um problema premente da Medicina e nesse âmbito é do nosso interesse perceber a evolução do mesmo. Resolvemos então caracterizar epidemiologicamente a resistência a antibióticos de última linha nas amostras do CHULN. Assim recolheu-se o perfil de susceptibilidade à terapêutica com vancomicina, linezolida e daptomicina dos isolamentos de microrganismos Gram positivo compreendidos entre 31 de Outubro de 2018 e 31 de Outubro de 2019. De seguida através da consulta de registos recolheu-se os dados epidemiológicos e clínicos relevantes.
Verificou-se que a resistência aos antibióticos de última linha no Centro Hospitalar Universitário Lisboa Norte (CHULN) é baixa e semelhante à descrita na literatura. Para Enterococcus spp. e em maior grau para E. faecium foi encontrada uma resistência bastante inferior à documentada, sobretudo em relação à vancomicina, tanto nos EUA como globalmente. Em Staphylococcus spp. a resistência a antibióticos de última linha mantém-se residual, de acordo com a epidemiologia mundial.
Os casos em que foi encontrada resistência estão mais associados a idades acima dos 70 anos e com algum factor causador de Imunossupressão, internamento prévio superior a 48 horas ou antecedente cirúrgico nos últimos três meses, todavia o factor mais importante parece ser antibioterapia recente, ainda que sem evidência de maior contribuição se por um dos fármacos em estudo.
Do ponto de vista epidemiológico seria importante, caracterizar a evolução temporal e possível emergência de resistências a antibióticos de última linha em bactérias Gram positivo a nível nacional.
Assim conclui-se salientando as limitações do trabalho, nomeadamente a índole retrospectiva, com dificuldade na colheita de dados, sugerindo-se um trabalho prospectivo por forma a confirmar e validar as conclusões.
Resistance to antibiotics has become one of the biggest challenges in modern medicine as such it is in our best interest to realize its state and evolution. Bearing this in mind we proceeded to characterize the epidemiology of Gram-positive infections resistant to therapy with the common last line, either vancomycin, linezolid or daptomycin, between the 31st October of 2018 and the same day the ensuing year in CHULN. After a brief consultation of medical records, we collected the epidemiological and clinical data thought to be relevant. We concluded that the resistance found is low and very similar to the one already published. For Enterococcus spp. and in a bigger extent to Enterococcus faecium we actually found a substantial lower percentage value of resistant organism, especially referring vancomycin, to the one reported internationally. Concerning Staphylococcus spp. the resistance recovered was as expected marginal and in agreement with international data. On this series resistance was found to be more likely in patients older than 70 years old with some sort of immunosuppression factor, previous stay in hospital grounds for more than 48 hours or surgery in the last three months. Even so the factor deemed more relevant seems to be previous antibiotic therapy, although there is no evidence of greater contribution if by one of the agents in analysis. It would be of great epidemiological value to characterize the temporal evolution and the appearance of resistance to the so-called last line of antibiotic in Gram-positive organism on a national level. As such, we conclude the present paper suggesting a new one of prospective matter in a way to validate and confirm the conclusions outlined in this one, since they are limited due to the retrospective approach taken and the lack of retrieving of some of the data deemed relevant.
Resistance to antibiotics has become one of the biggest challenges in modern medicine as such it is in our best interest to realize its state and evolution. Bearing this in mind we proceeded to characterize the epidemiology of Gram-positive infections resistant to therapy with the common last line, either vancomycin, linezolid or daptomycin, between the 31st October of 2018 and the same day the ensuing year in CHULN. After a brief consultation of medical records, we collected the epidemiological and clinical data thought to be relevant. We concluded that the resistance found is low and very similar to the one already published. For Enterococcus spp. and in a bigger extent to Enterococcus faecium we actually found a substantial lower percentage value of resistant organism, especially referring vancomycin, to the one reported internationally. Concerning Staphylococcus spp. the resistance recovered was as expected marginal and in agreement with international data. On this series resistance was found to be more likely in patients older than 70 years old with some sort of immunosuppression factor, previous stay in hospital grounds for more than 48 hours or surgery in the last three months. Even so the factor deemed more relevant seems to be previous antibiotic therapy, although there is no evidence of greater contribution if by one of the agents in analysis. It would be of great epidemiological value to characterize the temporal evolution and the appearance of resistance to the so-called last line of antibiotic in Gram-positive organism on a national level. As such, we conclude the present paper suggesting a new one of prospective matter in a way to validate and confirm the conclusions outlined in this one, since they are limited due to the retrospective approach taken and the lack of retrieving of some of the data deemed relevant.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Resistência a bactérias gram positivo Vancomicina Daptomicina Linezolida Doenças infecciosas