Bacteriúria em crianças com mielomeningocele: etiologia segundo idade e sexo e tendência no perfil de susceptibilidade antimicrobiana

Abstract

Myelomeningocele (MMC) children often have abnormal bladder function, known as neurogenic bladder (BN). The uncoordinated bladder-sphincter functioning and the use of clean intermittent catheterization contributes to urinary tract colonization and infection in these patients. Knowledge of the urinary microbiological profile of MMC children is sparse, despite its epidemiological importance. The aim of the study was to evaluate the prevalence and the antimicrobial resistance pattern of uropathogens of MMC children in a rehabilitation center in Rio de Janeiro - Brazil between 2010 and 2017. This retrospective study included 943 catheterized urine samples from 409 children aged between zero and 15 years, 454 from girls and 489 from boys, with aseptic technique. Cultures were performed using 5% sheep blood Columbia agar plate and MacConkey agar plate. The bacterial identification and susceptibility tests of those containing more than 104 CFU/mL were performed in Vitek 2 Compact. A total of 693 positives cultures were included in this analysis. In 559 (59.3%) grew one uropathogen and 134 (19.3%) had mixed growth. Positives cultures were significantly more prevalent in girls (83.5% versus 64.2%; p<0.001). The prevalence of positives cultures is directly proportional to age (p<0,001). 842 samples of microorganisms were isolated. Escherichia coli was the most common (55.8%), followed by Klebsiella pneumoniae (14.3%), Enterococcus faecalis (9.9%) and Proteus mirabilis (4.9%). Girls had more E. coli than boys (65.2% versus 43.9%; p<0.001). On the other hand, bacteriuria by others Enterobacterales is higher in boys (K. pneumoniae and P. mirabilis: p<0.001). The highest E. coli resistance to tested antimicrobials was seen for ampicillin (56.3%), cephalotin (46.1%), nalidixic acid (28.3%), levofloxacin (29.9%) and sulfamethoxazole-trimethoprim (38.0%). The overall Escherichia coli resistance from boys was higher than from girls (p=0.04). There was a correlation between age and resistance. Increased resistance with age was observed to amoxicillin-clavulanic acid (p=0.02), oral and parenteral cefuroxime (p<0.01), ceftriaxone (p=0.05), nalidixic acid (p< 0.01), ciprofloxacin (p<0.01), levofloxacin (p=0.02) and norfloxacin (p<0.01). E. coli did not show significantly changes in the resistance to tested antimicrobials over the study period. The ESBL phenotype was detected in 5.2% of E. coli and in 2.6% of K. pneumoniae. There was no difference between the frequency of ESBL-producing E. coli between boys and girls, neither significantly changes in this phenotype prevalence between 2010 and 2017. Among the Enterobacteriaceae, 21.7% were multidrug-resistant (MR) and 28.5% of the E. coli were MR. There was no difference in prevalence of E. coli MR between boys and girls. Increasing MR with age in boys was observed over the study period (p=0,03).