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Luiz de Macêdo Fariashttp://lattes.cnpq.br/3041207015099007Paula Prazeres MagalhãesMireille Ângela Bernardes Sousahttp://lattes.cnpq.br/3770014210888290Patrícia Maria de Carvalho Campos2022-01-27T20:01:15Z2022-01-27T20:01:15Z2018-02-28http://hdl.handle.net/1843/39193Klebsiella pneumoniae é um organismo de grande relevância clínica, associado à etiopatogenia tanto de infecções relacionadas à assistência à saúde como comunitárias, entre elas, infecção do trato urinário (ITU). Tem habilidade de adquirir e transferir genes de resistência a antimicrobianos, característica importante em sua emergência como patógeno resistente a múltiplos fármacos. Entre as enterobactérias, o principal mecanismo de resistência a antibacterianos β-lactâmicos, os mais frequentemente utilizadas na prática clínica, é a produção de enzimas β-lactamases. Devido à relevância clínica de K. pneumoniae, à sua associação com ITU comunitária e à disseminação da resistência antimicrobiana, o objetivo deste estudo foi avaliar a presença dos genes blaKPC1,2,3, blaSHV, blaCTX-M e blaTEM em 519 amostras de K. pneumoniae isoladas de ITU adquirida na comunidade e analisar o perfil de suscetibilidade antimicrobiana das amostras. Lise térmica foi utilizada para extraçao de DNA, empregado como molde em PCR para pesquisa dos marcadores genéticos mencionados. Ainda, os dados relativos ao perfil fenotípico de suscetibilidade antimicrobiana das amostras bacterianas, incluindo triagem de amostras produtoras de β-lactamases de espectro estendido (ESBLs) e KPC foram analisados. O estudo demonstrou que 51,6% das amostras de K. pneumoniae abrigavam pelo menos um dos genes pesquisados. As seguintes frequência relativas foram observadas: blaSHV= 46,1%; blaCTX-M = 7,3%; blaTEM= 5,6%; blaKPC = 1,0%. Dois e três marcadores foram detectados simultaneamente em 6,0% e 1,2% das amostras. No que se refere ao perfil de suscetibilidade antimicrobiana, a menor e maior taxa de resistência foram observadas para amicacina (0,2% resistência e 0,4% resistência intermediária) e ampicilina (100% resistência), respectivamente. De forma geral, observou-se predomínio de suscetibilidade aos antimicrobianos, com frequência superior àquelas habitualmente relatadas para o grupo. Destaca-se resistência/resistência intermediária à nitrofurantoína de 30,3%. Das 51 (9,8%) amostras que expressaram multirresistência, 41 apresentaram algum dos genes analisados, o que sugere que a produção de β lactamases está relacionada ao perfil de resistência observado. Conclui-se que as β-lactamases pesquisadas representam um importante mecanismo de resistência de K. pneumoniae associada à ITU comunitária, visto que mais da metade das amostras albergavam ao menos um dos quatro genes investigados. Além disso, mesmo as β-lactamases de espectro estreito, mais prevalentes em amostras bacterianas que circulam na comunidade, são capazes de comprometer a antibioticoterapia, considerando-se os esquemas comumente utilizados para tratamento de pacientes com infecções comunitárias, como cefalosporinas de primeira geração e penicilinas. Os resultados desta investigação contribuem para o entendimento da epidemiologia do quadro e para a proposição de antibioticoterapia empírica.Klebsiella pneumoniae is a clinically relevant organism associated with the etiopathogenesis of both healthcare-associated infections and community acquired infections, including urinary tract infection (UTI). The microorganism is able to acquire and transfer antimicrobial resistance genes and consequently to this ability the bacterium emerged as a multidrug resistant pathogen. The most commonly employed antimicrobial drugs in the clinical routine are β-lactams and among enterobacteria the most important resistance mechanism is the production of β-lactamases enzymes. Considering the clinical relevance of K. pneumoniae, its association with community acquired UTI, and the spread of antimicrobial resistance, we developed this study aiming to evaluate the presence of blaKPC1,2,3, blaSHV, blaCTX-M, and blaTEM among 519 K. pneumoniae isolates obtained from community-acquired UTI patients, and to analyze the antimicrobial susceptibility profile of bacterial isolates. After boiling extraction of DNA, PCR was performed in order to search for the genetic markers described above. Data on the phenotypic antimicrobial susceptibility profile including the screening for extended spectrum β-lactamases (ESBLs) producing isolates and KPC were analyzed. The study revealed that 51.6% of K. pneumoniae isolates harbored at least one of the studied markers. The following relative frequencies were observed: blaSHV = 46.1%; blaCTX-M = 7.3%; blaTEM = 5.6%; blaKPC = 1.0%. Two and three of these genes were detected simultaneously in 6.0% and 1.2% of K. pneumoniae strains, respectively. In regard to the antimicrobial susceptibility profile the lowest resistant rate was detected for amikacin (0.2% resistance and 0.4% intermediate resistance) and the highest frequency of resistance was observed for ampicillin (100% resistance). Overall high susceptibility rates were detected, most of them higher than those previously reported. However it is noteworthy the resistance/intermediate resistance frequency to nitrofurantoin (30.3%). Among the 51 (9.8%) multiresistant isolates 41 presented at least one of the genes evaluated in this study suggesting that the synthesis of β-lactamases is associated with the resistance profile. Data generated reinforce that β lactamases production is a relevant resistance mechanism among K. pneumoniae associated with community-acquired UTI, since more than half of the study group harbored at least one of the four genes investigated. Besides this, even the narrow-spectrum β-lactamases, which are more prevalent in bacterial strains that circulate in the community, may interfere in the antimicrobial therapy outcome considering the commonly drug regimens used for the treatment of patients with community-acquired infections, such as first generation cephalosporins and penicillins. Data generated by this study contribute to understanding the epidemiology of UTI and to the designing of more efficient empirical antimicrobial therapy.CNPq - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas GeraisCAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorOutra AgênciaporUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em MicrobiologiaUFMGBrasilICB - DEPARTAMENTO DE MICROBIOLOGIAhttp://creativecommons.org/licenses/by-nc-nd/3.0/pt/info:eu-repo/semantics/openAccessMicrobiologiaKlebsiella pneumoniaeInfecçõesKlebsiella pneumoniaeInfecção urináriaResistência antimicrobianaβ-lactâmicosβ-lactamasesPerfil de suscetibilidade e avaliação genotípica da resistência a β-lactâmicos em amostras de klebsiella pneumoniae isoladas de pacientes com infecção urinária adquirida na comunidade no Brasilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALPATRICIA MARIA DE CARVALHO CAMPOS.pdfPATRICIA MARIA DE CARVALHO CAMPOS.pdfapplication/pdf1352063https://repositorio.ufmg.br/bitstream/1843/39193/1/PATRICIA%20MARIA%20DE%20CARVALHO%20CAMPOS.pdfec1d7dc60a4ac6d0026a6a6d9784318bMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/39193/3/license.txtcda590c95a0b51b4d15f60c9642ca272MD53CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufmg.br/bitstream/1843/39193/2/license_rdfcfd6801dba008cb6adbd9838b81582abMD521843/391932022-01-27 17:01:17.021oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-01-27T20:01:17Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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