Perfis de resistência de cepas de Escherichia coli isoladas em urocultura e a correlação com os fatores de risco diversos para infecção do trato urinário

• Autor(a) principal: Seraphim, Claudia Patricia Albuquerque de Carvalho
• Data de Publicação: 2011
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/14408
• topic: Urinary system infection; Microbian resistance; UPEC; Infecção sistema urinário; Resistência microbiana; UPEC; CNPQ::CIENCIAS BIOLOGICAS::MICROBIOLOGIA

Urinary tract infections (UTIs) are one of the most common cause of medical visits. In the hospital setting, are the most common infections among health care associated infections (35 to 45%). In the United States of America, UTIs result in 3.6 million doctor visits annually and over 100,000 hospitalizations. In the UK, represent 23% of infections related to health care. Studies show that the bacterium E. coli is the most common microorganism isolated from urine cultures (75% to 80%), both in inpatients and in outpatients. Antibiotic treatment for UTI is usually initiated empirically before urine culture and antibiogram, so it is necessary to know the profile sensitivity and resistance of the likely etiologic agents and should consider clinical and epidemiological history of the patient. The present study was conducted to analyze the resistance of E. coli strains isolated from urine cultures in 261 patients assisted as outpatients and hospitalized patients at the Hospital Universitário Pedro Ernesto (HUPE) and also of 81 strains isolated in urine cultures of outpatients from a Municipal Maternity Hospital from Rio de Janeiro (MMHRJ), from May 2010 to December 2010. The antimicrobial susceptibility was determined by disk diffusion method of Kirby and Bauer. The phenotypic screening for ESBL production and confirmation of strains producing carbapenemases were performed. We conducted the clinical epidemiological research, using data contained in the records of patients with urine cultures positive for E. coli count ≥ 105 cfu / mL, to identify risk factors predisposing UTI by E. coli. It was observed that female patients are more suceptible to UTI and the use of antibiotics within 03 months before the infectious episode (p= 0,04746), diabetes (p= 0,01683), recent trauma (p= 0,000238), previous abdominal or pelvic surgery (p= 0,00221), chronic bladder disease (p= 0,002150), urinary catheter (p=0,0002), chronic renal failure (p= 0,02178), and previous hospitalization prior to 06 months (p= 0,01802), can be considered important risk factors for UTI by E. coli. And it was found that the use of urinary catheter (p=0,000399), abdominal or pelvic surgery (p=0,004458) and antibiotic use prior to the infectious process (p=0,002625) can be considered important risk factors for UTI by multidrug resistant E. coli. Although male patients represent the minority of patients with UTI, they represent the majority of patients with UTI by multidrug resistant E. coli, in the study. It was observed that the class of antimicrobial used within 03 months before the infectious episode enhances the chance of UTI by multidrug resistant E. coli, principally when associated to the use of urinary catheter and abdominal or pelvic surgery. The resistance profiles of strains isolated from outpatients and inpatients in the HUPE are similar. Althoug only a few multidrug strains were isolated from outpatients in the MMHRJ, they presented a resistance profile similar to the multidrug strains isolated from from outpatients and inpatients in the HUPE. Through the evidences, it is clear that the rational use of antimicrobials is very important to minimize the set of problems envolving the antimicrobial resistance