Colonização intestinal por bactérias Gram-negativas produtoras de ESBL, carbapenemases e AmpC em indivíduos hígidos da faixa etária pediátrica
Data
2022
Autores
Coraine, Ligia Augusto 
Orientadores
Silva, Rosa Maria
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Infecções relacionadas à assistência à saúde estão entre os principais eventos adversos em contexto hospitalar, com alta morbidade e mortalidade. Os agentes mais relevantes são Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas spp. e Staphylococcus aureus, pela alta prevalência e gravidade dos quadros. As taxas de resistência a antibióticos cresceram de forma desenfreada nos últimos anos, especialmente as ESBL e as carbapenemases. Existe clara relação entre as taxas de infecção por bactérias resistentes e a colonização prévia por esses agentes. O objetivo principal deste estudo foi conhecer, na população do Estado de São Paulo, a frequência de indivíduos hígidos, na faixa etária pediátrica, portadores de bactérias Gram-negativas produtoras das beta-lactamases de amplo espectro de ação: ESBL, AmpC e carbapenemases. De 100 crianças saudáveis entre zero e 18 anos de idade, 81 apresentaram em suas fezes pelo menos uma espécie bacteriana resistente ou intermediariamente resistente aos antibióticos utilizados na seleção: cefotaxima, ceftazidima e imipenem. Foram identificadas 96 espécies da Ordem Enterobacterales, em sua maioria E. coli (11 cepas) e Enterobacter spp. (15 cepas). Também estavam presentes 81 bacilos Gram-negativos não fermentadores (BGNNF), predominando Pseudomonas aeruginosa (26 cepas), Pseudomonas spp. (18 cepas), e Acinetobacter spp. (10 cepas). Cerca de 24% das enterobactérias e 24,7% dos BGNNF apresentaram fenótipo resistente ou intermediário (R/I) para as três drogas. Com relação aos mecanismos responsáveis por essa resistência, 17,7% das R/I produziram ESBL sensível ao clavulanato, 42,5% carbapenemases e 30,5% AmpC. De nota, 19,1% apresentaram dois mecanismos simultaneamente, 9,9% de carbapenemase/AmpC, 7,8% de ESBL/carbapenemase e, apenas uma cepa ESBL/AmpC ou ESBL/carbapenemase/AmpC. A distribuição desses mecanismos na população estudada foi de 24,7% dos indivíduos com AmpC, 28,4% com carbapenemases, 14,8% com ESBL, 14,8% com carbapenemase/AmpC, 12,3% com ESBL/carbapenemase e 1,2% com ESBL/AmpC ou ESBL/carbapenemase/AmpC. A caracterização genética desses mecanismos não teve sucesso ao detectá-los, na medida em que os genótipos encontrados não foram, em sua maioria, compatíveis com os fenótipos observados. Estes resultados mostram um panorama da epidemiologia da resistência pelos mecanismos estudados na população pediátrica no Estado de São Paulo. Além disso, são um alerta para a ocorrência da grande disseminação de mecanismos com potencial para conferir resistência a antimicrobianos de grande relevância na prática clínica.
Healthcare associated infections are some of the main adverse effects in hospital setting, with elevated morbidity and mortality. The most relevant causing agents are Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas spp. and Staphylococcus aureus, as a consequence of their prevalence and severity of the clinical conditions. The antibiotic resistance rates have grown out of control in the last years, especially with ESBL and carbapenemase production. There is a clear association between resistant bacterial infection rates and previous colonization with these strains. The goal of this research was to have knowledge, in healthy children in the State of São Paulo, the carriage rates of ESBL, AmpC and carbapenemase producing Gram-negative bacteria. One hundred feces samples were obtained from healthy children aged zero to 18 years old, and from 81 it was possible to obtain between 1 and 3 colonies in each plate containing antibiotic-enriched agar (cefotaxime, ceftazidime, imipenem). It was possible to identify 96 strains of Enterobacterale Order, most of them E. coli (11 strains) and Enterobacter (15 strains). There were also 81 non-fermentative Gram-negative bacilli (BGNNF), predominantly Pseudomonas aeruginosa (26 strains), Pseudomonas spp. (18 strains), and Acinetobacter spp. (10 strains). Around 24% of enterobacteria and 24,7% of BGNNF presented resistant or intermediate phenotype (R/I) for the three tested drugs. Regarding the mechanisms causing this resistance, 17,7% of the R/I produced ESBL clavulanate sensitive, 42,5% carbapenemase, and 30,5% AmpC. To note, 19,1% presented two mechanisms simultaneously, being 9,9% carbapanemase/AmpC, 7,8% ESBL/carbapenemase, and only one strain ESBL/AmpC or ESBL/carbapenemase/AmpC. The distribution these mechanisms in the studied population was 24,7% of individuals with AmpC, 28,4% with carbapenemase, 14,8% with ESBL, 14,8% with carbapenemase/AmpC, 12,3% with ESBL/carbapenemase and 1,2% with ESBL/AmpC or ESBL/carbapenemase/AmpC. The genotypic characterization of the mechanisms failed on detecting them, once that many genotypes could not be found, and most of the found ones were not compatible with the phenotype. In summary, the described data estimate the epidemiological situation of the pediatric population in the State of São Paulo. Furthermore, these results represent alarming numbers of dissemination of mechanisms that can potentially confer resistance to antibiotics with high clinical relevance.
Healthcare associated infections are some of the main adverse effects in hospital setting, with elevated morbidity and mortality. The most relevant causing agents are Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas spp. and Staphylococcus aureus, as a consequence of their prevalence and severity of the clinical conditions. The antibiotic resistance rates have grown out of control in the last years, especially with ESBL and carbapenemase production. There is a clear association between resistant bacterial infection rates and previous colonization with these strains. The goal of this research was to have knowledge, in healthy children in the State of São Paulo, the carriage rates of ESBL, AmpC and carbapenemase producing Gram-negative bacteria. One hundred feces samples were obtained from healthy children aged zero to 18 years old, and from 81 it was possible to obtain between 1 and 3 colonies in each plate containing antibiotic-enriched agar (cefotaxime, ceftazidime, imipenem). It was possible to identify 96 strains of Enterobacterale Order, most of them E. coli (11 strains) and Enterobacter (15 strains). There were also 81 non-fermentative Gram-negative bacilli (BGNNF), predominantly Pseudomonas aeruginosa (26 strains), Pseudomonas spp. (18 strains), and Acinetobacter spp. (10 strains). Around 24% of enterobacteria and 24,7% of BGNNF presented resistant or intermediate phenotype (R/I) for the three tested drugs. Regarding the mechanisms causing this resistance, 17,7% of the R/I produced ESBL clavulanate sensitive, 42,5% carbapenemase, and 30,5% AmpC. To note, 19,1% presented two mechanisms simultaneously, being 9,9% carbapanemase/AmpC, 7,8% ESBL/carbapenemase, and only one strain ESBL/AmpC or ESBL/carbapenemase/AmpC. The distribution these mechanisms in the studied population was 24,7% of individuals with AmpC, 28,4% with carbapenemase, 14,8% with ESBL, 14,8% with carbapenemase/AmpC, 12,3% with ESBL/carbapenemase and 1,2% with ESBL/AmpC or ESBL/carbapenemase/AmpC. The genotypic characterization of the mechanisms failed on detecting them, once that many genotypes could not be found, and most of the found ones were not compatible with the phenotype. In summary, the described data estimate the epidemiological situation of the pediatric population in the State of São Paulo. Furthermore, these results represent alarming numbers of dissemination of mechanisms that can potentially confer resistance to antibiotics with high clinical relevance.