Perfil do padrão de resistência a antibióticos dos uropatógenos isolados de pacientes admitidos em um Hospital e uma análise reflexiva sobre a iniciação científica

Abstract

Introduction: Urinary tract infections (UTI) are very prevalent and, in general, empirical antibiotic therapies are used due to the time required to obtain urine culture results. It is known, however, that the indiscriminate use of these medications contributes to the phenomenon of antimicrobial resistance. In this sense, knowledge about the local prevalence of uropathogens and their pattern of resistance to antimicrobials is essential for designing a more appropriate empirical treatment, aiming to avoid bacterial resistance and maximize therapeutic success. Objectives: Determine the frequency of uropathogens and the antibiotic resistance profile of patients with community UTI admitted to a hospital in October/2018-2020. Methodology: Data from 1602 positive urine cultures and antibiograms (sex, age, uropathogen species and sensitivity to antimicrobials) were tabulated and the prevalence of the species and the global resistance profile were calculate, by sex and age group. For comparisons, the Chi-square test was used, using Fisher's exact test when necessary (BioEstat program, adopting a p value < 0.05). Results: Globally, infections were more prevalent in women and the elderly. Bacteria were detected in 1528 urine cultures (95.38%), of which 1382 (90.44%) were Gram-negative and 146 (9.56%) were Gram-positive. The most prevalent species were: Escherichia coli (63.87%), Klebsiella pneumoniae (10.34%), Proteus mirabilis (5.69%), Pseudomonas aeruginosa (4.06%), and Enterococcus faecalis (4.06%). In both sexes, E. coli was significantly higher in adults compared to the elderly, while other species became more common in the latter group. Regarding the resistance profile, the tested aminoglycosides and carbapenems, Ceftazidime, Nitrofurantoin, Piperacillin+Tazobactam, and Fosfomycin had a resistance rate < 20%; Ceftriaxone/Cefotaxime, Cefepime and Amoxicillin+Clavulanate < 30% and the fluoroquinolones, Cefuroxime and Sulfometoxazol+Trimetropim < 40%. For several antibiotics, resistance rates were higher in the elderly compared to other ages. Discussion: The highest incidence of UTI in females and the elderly is already well documented, as well as the higher prevalence of infections caused by Gram-negative bacteria, especially enterobacteria. The change in the frequencies of uropathogens according to the age group is probably related to a greater occurrence of complicated UTI in the elderly. Such group would also be subject to infections with more resistant bacteria due to factors such as previous use of antibiotics and more frequent hospitalizations. Regarding antibiotic therapy, resistance rates < 20% are considered adequate for empirical use, such as aminoglycosides, carbapenems, Ceftazidime, Nitrofurantoin, Piperacillin+Tazobactam, and Fosfomycin. Conclusions: This study contributes to the choice of the most appropriate local empirical treatment. However, the dynamism of these analyzed profiles and the importance of their repetition from time to time stand out, given the environmental changes to which the pathogens are subjected.