Caracterização de cepas de enterobactérias multirresistentes isoladas em amostras de fezes de pacientes atendidos no Hospital Universitário Pedro Ernesto (HUPE)

Abstract

The intestinal microbiota of living organisms has a high concentration of complex and diversified microorganisms. In addition, it is a recognized reservoir of bacterial species involved in the establishment of infectious processes in a nosocomial and community environment. The Enterobacteriaceae family includes several species of Gram-negative rods with clinical importance, also they are part of the intestinal tract of humans and animals, being able to colonize the skin, urinary tract and respiratory tract. Fecal samples were collected from out and hospitalized patients attended at a University Hospital, and for the phenotypic antibiotic resistance rating was included four main groups of antimicrobials: cephalosporins, aminoglycosides, fluorquinolones and carbapenems. The strains were isolated through selective MacConkey media containing 32μg/mL cephalexin and 8μg/mL gentamicin. A total of 82 strains of 30 inpatients and 92 strains of 35 outpatient’s fecal samples were analyzed by antimicrobial susceptibility test. The most prevalent bacteria were Escherichia coli (32.93%), Citrobacter freundii (14.63%), Enterobacter cloacae (14.63%) and Klebsiella pneumoniae (13.41%) for nosocomial patients. Among the outpatients, the highest percentages were Escherichia coli (25.00%), Citrobacter freundii (18.48%) and Enterobacter cloacae (15.22%). In relation to the inpatient strains, 71.4% were resistant to first-generation cephalosporins, 22.3% of second-generation, 33.0% of third-generation, 35.7% of fourth-generation, 16.0% resistant to aminoglycosides, 42.8% resistant to fluoroquinolones and 21.4% resistant to carbapenems. Regarding resistance to antimicrobial groups of outpatient strains, 68.6% were resistant to first-generation cephalosporins, 9.0% of second-generation, 23.2% of third-generation, 13.1% of fourth-generation, 9.0% resistant to aminoglycosides, 11.1% resistant to fluoroquinolones and 12.1% resistant to carbapenems. The strains considered multidrug resistant were those that had resistance to 3 or more antimicrobial groups, corresponding to 32 inpatient strains (39.02%) and 12 outpatient strains (13.04%). Considering that the transfer of genetic elements of antimicrobial resistance is occurring uninterruptedly in the hospital and community environment, the results reinforce that measures of barrier to the transmission of microorganisms and the more judicious use of antimicrobials are necessary for the control of the dissemination of microorganisms housing elements of resistance.