Clinical, microbiological and pharmacoepidemiological identification of enterobacteria with increased resistance in a public hospital in Ceará

Abstract

Objectives: to identify the clinical, microbiological and pharmacoepidemiological profile of patients with enterobacteria with increased resistance in a public teaching hospital in Ceará. Methods: Observational and retrospective study, carried out between January 2020 and December 2021. The microbiological and demographic profile was obtained through microbiology laboratory reports and information obtained from medical records. Variable frequencies were compared using the Chi-square test, considering p < 0.05. Study approved with opinion of the ethics committee nº 3.697.674. Results: A total of 164 patients had positive culture results (n=248) for enterobacteria with an enhanced resistance profile. The highest proportion was male (60.98%, n=100, with a mean age of 58.9 years and mean hospitalization time was 51.3 days. Klebsiella pneumoniae was the most isolated bacteria (88.31%, n=218), with tracheal aspirate (39.11%, n=97) being the most prevalent type of culture, followed by blood culture (27.42%, n=68) and urine culture (16.94%, n=42). The blaKPC gene was the most prevalent, being identified in 49.19% (n=122) of the isolates, followed by blaNDM with 11.29% (n=28). When checking the sensitivity profile, it is noted that 68.55% of the isolates are sensitive to colistin and only about 30% to aminoglycosides. In 18.57% they already showed resistance to ceftazidime-avibactam. As for the clinical outcome, 57.32% (n=94) of the patients died. Previous use of antimicrobials (p=0.024), surgical procedure (p=0.049), admission to an intensive care unit (p<0.001), presence of neutropenia (p=0.005) and use of invasive devices (p<0.001) were statistically significant. Conclusion: These findings show the importance of knowing the clinical profile of patients infected with enterobacteria with increased resistance, since targeted strategies should be designed in favor of better management of antimicrobials against microorganisms such as K. pneumoniae, a strong candidate for the production of carbapenemase, an important cause of bacteremia and which can sometimes be resistant to last-choice antimicrobials, facts associated with high mortality.