Etiologia, perfil de resistência e pesquisa de enterobactérias produtoras de beta-lactamases isoladas em uroculturas de pacientes atendidos na rede pública de um município do Norte de Mato Grosso, um estudo retrospectivo

Abstract

Urinary tract infection (UTI) is an important infectious syndrome, highly prevalent in clinical practice, both in community and hospitalized individuals, caused by the presence and proliferation of microorganisms in the urinary tissue. The inappropriate use of antimicrobials in the treatment of UTIs, as well as other infections, can lead to a worsening of the clinical picture and contribute to the emergence of resistant bacterial strains. This study aimed to determine the etiology, sensibility profile and perform the research of enterobacteria producing beta-lactamase (ESBL, AmpC, KPC, MBL) isolated in urine cultures of patients treated by the public health network of the city of Sinop - MT, from October 2021 to December 2022. Data were collected from urine cultures of individuals over 18 years of age, of both genders, who sent their samples to the Municipal Laboratory of Clinical Analysis (LAMAC). During the research period, 12,340 urine cultures were performed, with 1,325 samples (10.74%) having a positive result, suggestive of UTI, among which 1.135 samples (85.66%) were isolated from females and 190 (14.34%) in males. The highest prevalence of UTI in women was observed between 18 and 39 years old, while in men the highest prevalence was observed in the group over 60 years old. Among the etiological agents isolated, Gram negative bacilli were the most prevalent, representing 95.40% of cases (n=1,264) and 61 Gram positive cocci (4.60%). Among enterobacteria, Escherichia coli was the main agent isolated in 71.32% of the samples (n=945), followed by Klebsiella ozaenae in 8.91% and Klebsiella aerogenes in 3,70% of UTIs. Analysis of the sensitivity profile revealed values above 80% for beta-lactam antimicrobials, aminoglycosides, nitrofurantoin and fosfomycin, with the lowest sensitivity indices being observed for ciprofloxacin (33.69%), norfloxacin (36.54%) and sulfamethoxazole – trimethoprim (41.22%). Among the enterobacteria were phenotypically detected, 167 (13.57%) extended-spectrum beta-lactamase (ESBL) producing strains, 37 (3.01%) AmpC betalactamase producing strains and 14 (1.14%) KPC carbapenemases, with 245 isolates (19.90%) having a multidrug resistant (MDR) profile, with resistance to one or more drugs from more than three different classes of antimicrobials. Considering that UTI is one of the most common causes of infection in the general population, it is important to know the etiology, resistance profile of bacteria and specific phenotypes for better management of patient care and treatment.