Enterobactérias produtoras de ESBL em Passo Fundo, estado do Rio Grande do Sul, Brasil

Abstract

RESUMOIntrodução: O principal mecanismo de resistência emergente entre Enterobacteriaceae é a produção de β-lactamases de espectro estendido, enzimas capazes de hidrolisar cefalosporinasde-amplo-espectro, que são bastante utilizadas na terapia antimicrobiana de infecções por enterobactérias. Embora a resistência a esses agentes apresente grande variabilidade geográfica, os índices de resistência são elevados em diversos países. ABSTRACT Introduction:The main emerging resistance mechanism relating to Enterobacteriaceae is represented by production of extended spectrum β-lactamases (ESBLs). These enzymes have the capacity to hydrolyze broad-spectrum cephalosporins and are greatly used for antimicrobial chemotherapy on enterobacterial infections. Although resistance to these agents presents remarkable geographical variability, the resistance rates are high in many countries. Methods: A retrospective observational cross-sectional descriptive study was developed to evaluate the frequency of ESBLs among Enterobacteriaceae strains obtained from Hospital São Vicente de Paulo, Brazil. Results: ESBL production was noted in 24.8% (n = 208/838) of the isolates evaluated. Isolates of Escherichia coli represented 46.2% (n = 96/208) of the ESBL producers, followed by Enterobacter species (30.3%; n = 63/208). The sensitivity of these isolates to meropenem was 91.4% and to piperacillin/tazobactam, 67.4%. Conclusions: The ESBL levels founded confirm the worldwide concern regarding this resistance mechanism.

Occurrence and sensitivity profile of extended spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary hospital in Southern Brazil

“…In our study, ESBL production was detected in different genera, with an overall prevalence of 30.3% in the strains tested and the majority of positive isolates belonging to Enterobacter sp., Escherichia coli, and Klebsiella sp. Similar percentages were reported in other studies conducted by Seki et al (14) (40.2%), Lenhard-Vidal et al (15) (16) was conducted at the same hospital as the present study.…”

Microbial resistance and frequency of extended-spectrum beta-lactamase (ESBL) in isolated from blood cultures

“…Gram-negative bacilli are among the main bacterial strains responsible for nosocomial infections, thus, it is important to study them in this environment, especially as regards the development of resistance mechanisms (10) . In contrast to these results, Alves et al (2012) analyzed 170 blood cultures of patients admitted to the ICU, from a hospital in São José dos Campos-SP, from January to July 2011, and found the following bacterial genus: Pseudomonas aeruginosa (12.2%), Klebsiella pneumoniae (8.1%), Acinetobacter baumanii (3.3%), Enterobacter cloacae (0.8%), Escherichia coli (0.8%), and Proteus mirabilis (0.8%) (1) .…”

“…However, it is noteworthy that the increase on ESBL occurrence in other Enterobacteriaceae reveals the importance of extending this detection in other species than Escherichia coli and Klebsiella sp. (10) . Lago et al (2010) reported that 49.6% of their isolated ESBLproducing were Enterobacter sp., showing that, since the pathogen is identified as Enterobacter sp., it is 8.43 times more likely to be ESBL-producing (10) .…”

“…(10) . Lago et al (2010) reported that 49.6% of their isolated ESBLproducing were Enterobacter sp., showing that, since the pathogen is identified as Enterobacter sp., it is 8.43 times more likely to be ESBL-producing (10) . In Japan, a study carried out by Datta et al (2014) showed that in a number of 60 Enterobacteriaceae strains, 60% (n = 36) were identified as Proteus mirabilis and considered ESBL-producing, drawing attention to the fact these bacteria may not be detected by most clinical laboratories, suppressing some managements of assistance to the patient (5) .…”

“…ESBLs provide resistance to penicillins, all cephalosporins, and monobactams (including, aztreonam), but do not provide resistance to cephamycins (cefoxitin and cefotetan) and carbapenems (imipenem, meropenem, and ertapenem) (10) , however, they are inhibited by beta-lactamases inhibitors, such as clavulanic acid, sulbactam and tazobactam (18) . ESBLs are derived from genetic mutations (temoneira [TEM] and sulfidril variable [SHV]), and are found mainly in Escherichia coli and Klebsiella sp., but can also be detected in Proteus mirabilis, Enterobacter sp., Acinetobacter sp., Pseudomonas sp., and other Enterobacteriaceae species (8) .…”