Resistência bacteriana dos uropatógenos de pacientes em um Hospital Militar: implicações na terapia antimicrobiana empírica

Abstract

Urinary tract infection (UTI) is common pathology that affects humans, being the second most frequent infection in the general population. The significant increase in the rates of antimicrobial resistance that uropathogens of urinary tract infection develop is a major challenge for global public health, especially in the hospital setting. Therefore, one of the rational ways to positively influence treatment and reduce the degree of uncertainty in empirical therapy is knowledge of regional epidemiology and the pattern of susceptibility to antimicrobial agents. Urinary culture reports, considered positive, was insert in the study, with the aim of analyzing profiles and temporal trends of bacterial resistance of uropathogens, to help in the elaboration of protocols for the use of empirical antimicrobials for the treatment of UTI and bacteriuria, both community and hospital. We performed a retrospective study, recording 825 reports of positive urine cultures from patients submitted to microbiological analyses. The analysis included Gram-negative uropathogens isolated from asymptomatic bacteriuria (AB) and UTI samples. The microorganisms isolated were E. coli (72.9%), Klebsiella pneumoniae (13%), Proteus mirabilis (5.7%), Acinetobacter Bahmani (2.09%) and others (6.28%). The bacteria highlighted in UTI, E. coli, more prevalent in the community, showed greater resistance to nalidixic acid (47%) and ciprofloxacin (62%). However, the strains were sensitive to tigecycline (100%), fosfomycin (99%) and imipenem (99%). By analyzing the sensitivity profile of these isolated bacteria, it was possible to identify a trend towards the growth of strains resistant to fluoroquinolones and carbapenems. Research like this one can help in the development of protocols for the use of empirical antimicrobials for the treatment of UTI and community and hospital bacteriuria. Being able to discriminate BA and UTI in the elderly can be a great advance for clinical management.