A carregar...
Publicação
Evolução do perfil de suscetibilidade aos antibióticos de isolados bacterianos em uroculturas do laboratório da Cintramédica em dois períodos distintos (2014 e 2018)
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.82 MB | Adobe PDF |
Autores
Resumo(s)
As infeções do trato urinário (ITU) são uma das principais infeções bacterianas que afetam o ser Humano, figurando como a segunda infeção mais comum na população em geral, logo a seguir às infeções respiratórias. As uroculturas representam uma das análises mais solicitadas na área da microbiologia clínica para o diagnóstico das ITUs. Assim, inicialmente foi avaliada a prevalência de ITUs no laboratório Cintramédica, através da análise de uroculturas realizadas durante o ano de 2014 e 2018, com o objetivo de conhecer as estirpes mais prevalentes nas infeções urinárias do laboratório Cintramédica e avaliar a evolução das resistências aos antibióticos, nos períodos estudados (2014 e 2018). Das amostras estudadas apenas foram consideradas as amostras das uroculturas positivas (17,5% em 2014 e 31,8% em 2018). Das uroculturas positivas, 78,9% em 2014 e 78,8% em 2018 são referentes a indivíduos do sexo feminino. Assim como em vários estudos, este também permitiu confirmar que existe uma maior frequência de infeção urinária nas mulheres e isso pode dever-se a vários fatores tais como a proximidade da uretra feminina com o ânus e também com a vida sexual mais ativa e consequentemente com o aumento do número de mulheres grávidas. Em ambos os sexos, a partir dos 50 anos, as modificações anatómicas e fisiológicas predispõem a ITU. A maioria das infeções são provocadas por relativamente poucas espécies. Muitos destes organismos podem ser encontrados como parte da microbiota comensal uretral e fecal. A ITU é comumente provocada pelas bactérias da microbiota intestinal do próprio hospedeiro que entram no trato urinário por via ascendente através da uretra. A gravidade da ITU depende tanto da virulência das bactérias quanto da suscetibilidade do hospedeiro. O agente etiológico mais frequente foi Escherichia coli (60,9% em 2014 e 57,9% em 2018), seguida de Klebsiella pneumoniae (9,7% em 2014 e 13% em 2018), Proteus mirabilis (5,9% em 2014 e 7,9% em 2018), Pseudomonas aeruginosa (4,6% em 2014 e 3,8% em 2018), Enterococcus faecalis (4,3% em 2014 e 4,4% em 2018) e Staphylococcus saprophyticus (2,6% em 2014 e 1,1% em 2018). As infeções urinárias são frequentemente tratadas com antibióticos de largo espectro, deixando os antibióticos de espectro restrito apenas para as infeções causadas por microrganismos resistentes. Os antibióticos mais utilizados para combater as infeções urinárias são trimetoprim-sulfametoxazol (cotrimoxazol), nitrofurantoína, fosfomicina, beta-lactâmicos e fluoroquinolonas. Escherichia coli apresentou uma maior taxa de sensibilidade a nitrofurantoína e a fosfomicina (98% em 2014 e 97% em 2018 respetivamente). Klebsiella pneumoniae apresentou maior taxa de sensibilidade a cefoxitina (86% em 2014 e 89% em 2018). Proteus mirabilis apresentou uma boa taxa de sensibilidade para a maioria dos antibióticos testados exceto para ampicilina, ciprofloxacina e trimetropim/sulfametaxazol. Pseudomonas aeruginosa é frequentemente resistente a muitos antibióticos comumente usados, deste modo, é recomendo que o tratamento seja orientado conforme a sensibilidade de cada isolado e monitorado frequentemente. Foi analisado o perfil de suscetibilidade aos antibióticos destas estirpes e verificou-se que, em 2018, houve uma diminuição das resistências aos antibióticos em Escherichia coli e um aumento das resistências aos antibióticos em Klebsiella pneumoniae. De acordo com o guia multidisciplinar reconhecido pela Associação Portuguesa da Urologia, o padrão de resistência das estirpes que causam infeções urinárias não complicadas pode variar amplamente entre regiões geográficas de um mesmo país ou de países diferentes, pelo que é inadequado dar recomendações generalizadas. Também se deve ter em conta que os dados procedentes de antibiogramas podem sobrestimar as resistências entre patogénicos que causam infeções urinárias e podem confundir os clínicos sobre a prevalência das resistências a nível local. Este estudo permitiu conhecer os agentes etilológicos mais frequentes e os padrões de sensibilidade aos antibióticos das ITU na área geográfica do laboratório Cintramédica. Quanto à adequação da recomendação da Norma DGS nº 015/2011 para tratamento de cistite não complicada na mulher, conclui-se que os antibióticos recomendados continuam a ser uma boa opção terapêutica, contudo em cerca de 30% dos casos há risco de insucesso terapêutico, pelo que a urocultura após o tratamento empírico continua a ser um procedimento importante. É de grande importância o conhecimento do perfil de suscetibilidade antimicrobiana das bactérias causadoras de infeção urinária, para ajudar os clínicos a escolher o tratamento empírico mais correto. Também é de salientar que a via oral e os tratamentos curtos apresentam algumas vantagens nomeadamente uma melhor adesão do utente ao tratamento, são mais económicos, bem como apresentam menos riscos e efeitos adversos. Portanto, o uso racional de antibióticos, respeitando dose e tempo de tratamento, e o conhecimento dos agentes mais frequentes e dos respetivos perfis de sensibilidade na comunidade são mandatórios, visto a necessidade de se evitar falhas terapêuticas e seleção de microrganismos resistentes.
Urinary tract infections (UTI) are one of the main bacterial infections that affect the human being, being the second most common infection in the general population, after respiratory infections. Urocultures represent one of the most requested analyzes in the field of clinical microbiology for the diagnosis of UTIs. Thus, it was initially assessed the prevalence of UTIs in the Cintramédica laboratory, through the analysis of urocultures performed during the years 2014 and 2018, with the objective of knowing the most prevalent strains in the urinary infections of the Cintramédica laboratory and assessing the evolution of antibiotic resistance, in the studied periods (2014 and 2018). Of the studied samples, only samples of positive urine cultures were considered (17.5% in 2014 and 31.8% in 2018). Of the positive urine cultures, 78.9% in 2014 and 78.8% in 2018 are related to female individuals. As in several studies, this also confirmed that there is a higher frequency of urinary infection in women and this may be due to several factors such as the proximity of the female urethra to the anus and also with a more active sex life and consequently with the increase in the number of pregnant women. In both sexes, from the age of 50, anatomical and physiological changes predispose to UTI. Most infections are caused by relatively few species. Many of these organisms can be found as part of the urethral and fecal commensal microbiota. UTI is commonly caused by bacteria from the host's intestinal microbiota that enter the urinary tract upwardly through the urethra. The severity of UTI depends on both the virulence of the bacteria and the susceptibility of the host. The most frequent etiologic agent was Escherichia coli (60.9% in 2014 and 57.9% in 2018), followed by Klebsiella pneumoniae (9.7% in 2014 and 13% in 2018), Proteus mirabilis (5.9% in 2014 and 7.9% in 2018), Pseudomonas aeruginosa (4.6% in 2014 and 3.8% in 2018), Enterococcus faecalis (4.3% in 2014 and 4.4% in 2018) and Staphylococcus saprophyticus (2 , 6% in 2014 and 1.1% in 2018). Urinary infections are often treated with broad-spectrum antibiotics, leaving restricted-spectrum antibiotics only for infections caused by resistant microorganisms. The antibiotics most used to fight urinary tract infections are trimethoprim-sulfamethoxazole (cotrimoxazole), nitrofurantoin, fosfomycin, beta-lactams and fluoroquinolones. Escherichia coli showed a higher rate of sensitivity to nitrofurantoin and fosfomycin (98% in 2014 and 97% in 2018 respectively). Klebsiella pneumoniae showed a higher rate of sensitivity to cefoxitin (86% in 2014 and 89% in 2018). Proteus mirabilis showed a good sensitivity rate for most of the antibiotics tested except for ampicillin, ciprofloxacin and trimetropim/sulfametaxazole. Pseudomonas aeruginosa is often resistant to many commonly used antibiotics, so it is recommended that treatment be guided according to the sensitivity of each isolate and monitored frequently. The antibiotic susceptibility profile of these strains was analyzed and it was found that, in 2018, there was a decrease in antibiotic resistance in Escherichia coli and an increase in antibiotic resistance in Klebsiella pneumoniae. According to the multidisciplinary guide recognized by the Portuguese Association of Urology, the resistance pattern of strains that cause uncomplicated urinary infections can vary widely between geographical regions of the same country or different countries, so it is inappropriate to give generalized recommendations. It should also be borne in mind that data from antibiograms can overestimate the resistance among pathogens that cause urinary infections and may confuse clinicians about the prevalence of resistance at the local level. This study allowed to know the most frequent etiological agents and the antibiotic sensitivity patterns of UTI in the geographical area of the Cintramédica laboratory. As for the adequacy of the recommendation of DGS Norm No. 015/2011 for the treatment of uncomplicated cystitis in women, it is concluded that the recommended antibiotics remain a good therapeutic option, however in about 30% of cases there is a risk of therapeutic failure, so uroculture after empirical treatment remains an important procedure. It is of great importance to know the antimicrobial susceptibility profile of bacteria that cause urinary infection, to help clinicians choose the most correct empirical treatment. It is also noted that the oral route and short treatments have some advantages, namely better user adherence to treatment, are more economical, as well as presenting fewer risks and adverse effects. Therefore, the rational use of antibiotics, respecting the dose and time of treatment, and the knowledge of the most frequent agents and the respective sensitivity profiles in the community are mandatory, given the need to avoid therapeutic failures and the selection of resistant microorganisms.
Urinary tract infections (UTI) are one of the main bacterial infections that affect the human being, being the second most common infection in the general population, after respiratory infections. Urocultures represent one of the most requested analyzes in the field of clinical microbiology for the diagnosis of UTIs. Thus, it was initially assessed the prevalence of UTIs in the Cintramédica laboratory, through the analysis of urocultures performed during the years 2014 and 2018, with the objective of knowing the most prevalent strains in the urinary infections of the Cintramédica laboratory and assessing the evolution of antibiotic resistance, in the studied periods (2014 and 2018). Of the studied samples, only samples of positive urine cultures were considered (17.5% in 2014 and 31.8% in 2018). Of the positive urine cultures, 78.9% in 2014 and 78.8% in 2018 are related to female individuals. As in several studies, this also confirmed that there is a higher frequency of urinary infection in women and this may be due to several factors such as the proximity of the female urethra to the anus and also with a more active sex life and consequently with the increase in the number of pregnant women. In both sexes, from the age of 50, anatomical and physiological changes predispose to UTI. Most infections are caused by relatively few species. Many of these organisms can be found as part of the urethral and fecal commensal microbiota. UTI is commonly caused by bacteria from the host's intestinal microbiota that enter the urinary tract upwardly through the urethra. The severity of UTI depends on both the virulence of the bacteria and the susceptibility of the host. The most frequent etiologic agent was Escherichia coli (60.9% in 2014 and 57.9% in 2018), followed by Klebsiella pneumoniae (9.7% in 2014 and 13% in 2018), Proteus mirabilis (5.9% in 2014 and 7.9% in 2018), Pseudomonas aeruginosa (4.6% in 2014 and 3.8% in 2018), Enterococcus faecalis (4.3% in 2014 and 4.4% in 2018) and Staphylococcus saprophyticus (2 , 6% in 2014 and 1.1% in 2018). Urinary infections are often treated with broad-spectrum antibiotics, leaving restricted-spectrum antibiotics only for infections caused by resistant microorganisms. The antibiotics most used to fight urinary tract infections are trimethoprim-sulfamethoxazole (cotrimoxazole), nitrofurantoin, fosfomycin, beta-lactams and fluoroquinolones. Escherichia coli showed a higher rate of sensitivity to nitrofurantoin and fosfomycin (98% in 2014 and 97% in 2018 respectively). Klebsiella pneumoniae showed a higher rate of sensitivity to cefoxitin (86% in 2014 and 89% in 2018). Proteus mirabilis showed a good sensitivity rate for most of the antibiotics tested except for ampicillin, ciprofloxacin and trimetropim/sulfametaxazole. Pseudomonas aeruginosa is often resistant to many commonly used antibiotics, so it is recommended that treatment be guided according to the sensitivity of each isolate and monitored frequently. The antibiotic susceptibility profile of these strains was analyzed and it was found that, in 2018, there was a decrease in antibiotic resistance in Escherichia coli and an increase in antibiotic resistance in Klebsiella pneumoniae. According to the multidisciplinary guide recognized by the Portuguese Association of Urology, the resistance pattern of strains that cause uncomplicated urinary infections can vary widely between geographical regions of the same country or different countries, so it is inappropriate to give generalized recommendations. It should also be borne in mind that data from antibiograms can overestimate the resistance among pathogens that cause urinary infections and may confuse clinicians about the prevalence of resistance at the local level. This study allowed to know the most frequent etiological agents and the antibiotic sensitivity patterns of UTI in the geographical area of the Cintramédica laboratory. As for the adequacy of the recommendation of DGS Norm No. 015/2011 for the treatment of uncomplicated cystitis in women, it is concluded that the recommended antibiotics remain a good therapeutic option, however in about 30% of cases there is a risk of therapeutic failure, so uroculture after empirical treatment remains an important procedure. It is of great importance to know the antimicrobial susceptibility profile of bacteria that cause urinary infection, to help clinicians choose the most correct empirical treatment. It is also noted that the oral route and short treatments have some advantages, namely better user adherence to treatment, are more economical, as well as presenting fewer risks and adverse effects. Therefore, the rational use of antibiotics, respecting the dose and time of treatment, and the knowledge of the most frequent agents and the respective sensitivity profiles in the community are mandatory, given the need to avoid therapeutic failures and the selection of resistant microorganisms.
Descrição
Tese de mestrado em Microbiologia Aplicada, Universidade de Lisboa, Faculdade de Ciências, 2020
Palavras-chave
Infeções do trato urinário Escherichia coli Klebsiella pneumoniae Tratamento infeções urinárias Teses de mestrado - 2020