| Congresso Brasileiro de Microbiologia 2023 | Resumo: 1254-1 | ||||
Resumo:Bacterial resistance to antimicrobials has proven to be a challenging public health problem. Alternatives have been implemented in a scenario where new resistance mechanisms displace usual antimicrobial classes in treating infections. In this perspective, one finds ceftazidime-avibactam (CAZ-AVI). This association has activity against Enterobacterales and Pseudomonas aeruginosa, producing Class A carbapenemases, ESBL and AmpC, representing a potentially effective therapeutic option when alternatives for using beta-lactams cease. However, permanent surveillance is necessary when cases of resistance to CAZ-AVI have been previously described. In this sense, our objective was to investigate, in a compilation of hospital microbiological data, the occurrence of gram-negative bacteria resistant to CAZ-AVI isolated in a private hospital from the metropolitan region of Rio de Janeiro between August/2019 and December/2022. Microbiological data compiled in the SPSS software database of 1,589 strains isolated from 744 patients at a private hospital in Niterói for 41 months were analyzed. The strains were identified by MALDI-TOF mass spectrometry, tested for antimicrobial susceptibility by VITEK, and classified according to the susceptibility profile according to BrCAST (2019 to 2022). Of the 1,589 strains, 98 (6.2%) were resistant to CAZ-AVI with MIC ranging from 8 to >256 µg/mL. Strains of 10 bacterial species were resistant, the most frequent being Klebsiella pneumoniae (n = 40) and P. aeruginosa (n = 35), followed by Escherichia coli (n = 7), Klebsiella oxytoca (n = 5), Morganella morganii (n = 3), Providencia stuartii (n = 3), Citrobacter freundii (n = 2), Citrobacter youngae (n = 1), Klebsiella aerogenes (n = 1) and Proteus vulgaris (n = 1). These strains were isolated primarily from sputum (n = 65), midstream urine (n = 12), and blood cultures (n = 10) of 41 patients (5.5%). The highest rates of isolation occurred in the hospital sectors Intensive Care Units (ICU; n = 35), Clinical Units (n = 28), and Surgical Center (n = 25), while the lowest rates were in the Transplant sector (n = 4), Emergency (n = 4) and Pediatric Units (n = 2). While K. pneumoniae strains were the majority among CAZ-AVI resistant strains in the Surgical Center (n = 18) and Clinical Units (n = 11), CAZ-AVI resistant P. aeruginosa strains formed the majority in the ICU (n = 20). In the analyzed period, there was an increase in the isolation of strains resistant to CAZ-AVI in the quarter from October to December/2021 (n = 24), with a peak between April and June/2022 (n = 29). As for beta-lactamase production, only one of the CAZ-AVI-resistant strains produced ESBL, whereas 51 produced carbapenemases, mainly by metallo-beta-lactamases (n = 47). Interestingly, four strains produced Class A carbapenemases, three K. pneumoniae, and one C. freundii, all isolated at different times. Resistance to other antimicrobial classes was observed in 88.8% of the CAZ-AVI resistant strains tested for ciprofloxacin; 47.7% to gentamicin; 36.1% to polymyxin B; 35.7% to tobramycin; and, 25% to amikacin. All strains tested for tigecycline (n = 5) were susceptible. Therefore, resistance to CAZ-AVI must be considered in treating gram-negative bacterial infections. Palavras-chave: Enterobacterales, Metallo-beta-lactamases, New beta-lactamase inhibitors, Pseudomonas aeruginosa Agência de fomento:Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) | |||||