Perfil epidemiológico de enterobactérias multirresistentes em hospital público no Ceará

Abstract

The indiscriminate use of antibiotics has led to the emergence of antimicrobial resistance, becoming a major public health problem worldwide. In this context, bacteria from the Enterobacteriales family, especially Klebsiella pneumoniae, are responsible for the high mortality in healthcare-associated infections. The objective of this work is to evaluate the epidemiological profile of multidrug-resistant enterobacteria in a reference public hospital in Ceará. This is a descriptive and retrospective study, carried out from January 2010 to December 2021. The variables used were: demographic profile, microbiological profile, risk factors and clinical-infectious profile, obtained through reports provided by the laboratory of microbiology and information obtained from medical records. The Chi-square test was applied, and the statistical analyzes were considered significant when p < 0.05. A total of 164 patients had a positive culture result (N=248) for enterobacteria with an enhanced resistance profile. The highest proportion was male (60.98%). The mean age was 58.9 years and the mean length of stay of patients in the hospital was 51.3 days. Klebsiella pneumoniae was the most isolated bacteria (88.31%), with tracheal aspirate (39.11%) being the most prevalent type of culture. Regarding microbial resistance, it was observed that the majority (81.05%) were sensitive to only one or two classes of antimicrobials (Extensively drug-resistant – XDR). The KPC gene was the most prevalent, being identified in 49.19% of the isolates. It was found that 99.6% and 16.19% of the bacteria were positive, respectively, for mCIM and eCIM, indicating that most bacteria (83.47%) expressed serine carbapenemase. When checking the sensitivity profile, it is noted that 68.82% are sensitive to colistin, 29.15% to amikacin, 25.50% to gentamicin and 77.82% to ceftazidime-avibactam. Regarding risk factors for death, previous use of antimicrobials, previous surgical procedure, ICU stay, presence of neutropenia and use of invasive devices were statistically significant. Therefore, managing the appropriate use of antimicrobials, carrying out bundles and audits are important tools for reducing the spread of infections caused by multidrug-resistant microorganisms.