| Congresso Brasileiro de Microbiologia 2023 | Resumo: 48-1 | ||||
Resumo:Resistance to carbapenems in Gram-negative bacteria has caused a global epidemic that continues to grow. With the advent of new drugs, such as ceftazidime/avibactam, which are ineffective against certain types of carbapenemases, the identification of mechanisms of resistance to carbapenems by clinical microbiology laboratories has become a challenge. In a retrospective study, 65 non-duplicated Enterobacterales isolates were selected from samples of urine, blood, tracheal aspirate and secretions from the abdominal and pelvic cavity, from January 2020 to January 2023. The present study aimed to evaluate the most prevalent species and the origin of the patients where they were recovered, the profile of resistance to antimicrobials and the genetic determinants of resistance to carbapenems in this period. Bacterial identification at the species level and antimicrobial susceptibility testing were determined by the Vitek2 system (Biomérieux). The blaKPC, blaNDM, blaOXA-48, blaSPM and blaVIM genes were searched by conventional PCR. The most prevalent species was Klebsiella pneumoniae (78.5%), followed by Escherichia coli (10.8%), Klebsiella aerogenes (4.6%), Enterobacter cloacae (4.6%) and Klebsiella oxytoca (1.5%). These isolates were identified in urine samples (63%), tracheal aspirate (21.6%), blood (12.3%), pelvic secretions (1.5%) and abdominal secretions (1.5%) and most of the patients came from inpatient units (33.8%), but also from the ICU (32.3%), emergency room (20%), outpatient clinics (12.3%) and neonatal ICU (1.5%). All isolates were resistant to cefuroxime, ceftazidime, cefepime, ertapenem and tazobactam/piperacillin. Some susceptibility was noted to ciprofloxacin (9.2%) and meropenem (1.5%). For gentamicin, susceptibility was observed in 60% of the isolates. The blaKPC gene was identified in 25 isolates (38.5%), while blaNDM in 18 (27.7%) and blaOXA-48 in 3 (4.6%). There was simultaneous detection of blaKPC and blaNDM in 4 isolates (6.1%) and 15 were negative for all five genes investigated (23%). The blaSPM and blaVIM genes were not detected. Our results corroborate studies carried out with Brazilian isolates of Enterobacterales, showing KPC as the most prevalent mechanism of resistance to carbapenems. However, other enzymatic mechanisms have gained relevance in our hospital, such as NDM, and also the co-production of different enzymes, as observed in our isolates. In this scenario of multidrug resistance, aminoglycosides, such as gentamicin, proved to be good therapeutic options in 60% of cases, which highlights the importance of monitoring their rational use. Finally, the identification of strains carrying genes encoding carbapenemases in outpatients highlights the concept of One Health, that should be adopted as a public health strategy. Palavras-chave: carbapenem resistance, Enterobacterales, molecular epidemiology, multidrug resistance | |||||