Universidade Federal do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil.
Universidade Federal do Paraná, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Laboratório de Microbiologia, Curitiba, PR, Brazil.
Braz J Infect Dis. 2020 Sep-Oct;24(5):380-385. doi: 10.1016/j.bjid.2020.07.006. Epub 2020 Aug 28.
Gram-negative bacilli (GNB), notably Acinetobacter spp., Pseudomonas spp., and Klebsiella spp., are becoming increasingly resistant to carbapenems and are associated with high health care costs and mortality, becoming a global concern.
To determine the prevalence rates of carbapenem resistance among Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. in the main sites of nosocomial infection at a tertiary care hospital in southern Brazil and the consequent therapeutic implications.
Cultures processed at the institution's laboratory in 2017 were analyzed, and those positive for Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. were identified. Antibiograms were evaluated for meropenem sensitivity following the Clinical Laboratory Standards Institute guidelines.
Acinetobacter spp. had the lowest prevalence among the three GNB, and resistance of this pathogen to meropenem at different sites of infection ranged from 36% (blood) to 82% (respiratory tract). Pseudomonas spp. was highly prevalent at the respiratory tract (31%) and had a high resistance rate to meropenem in rectal swab samples (71%), but a relatively low frequency at infection sites (skin/soft tissue, 13%; blood, 25%). Klebsiella spp. was identified in 7.5% of the blood cultures and 15% of the urine cultures and was the chief colonizer among all pathogens, representing 54% of all rectal swab samples, of which 53% were meropenem resistant. At sites of infection, rates of Klebsiella spp. resistant to meropenem ranged from 19% (skin) to 55% (vascular catheter).
The prevalence of carbapenem-resistant GNB at our hospital was relatively low compared to national and international data; thus, meropenem remains a good therapeutic option against these bacteria. Other antibiotics effective against GNB, such as ceftazidime, cefepime, and piperacillin-tazobactam, can be used in most cases, while meropenem should be reserved for patients with sepsis. Strict contact precaution measures are still needed, given the high resistance rate observed at the colonizing site.
革兰氏阴性杆菌（GNB），尤其是不动杆菌属、假单胞菌属和克雷伯氏菌属，对碳青霉烯类的耐药性日益增强，与高昂的医疗保健费用和高死亡率相关，成为全球关注的问题。
确定巴西南部一家三级保健医院主要医院感染部位耐碳青霉烯类不动杆菌属、假单胞菌属和克雷伯氏菌属的流行率及其治疗意义。
分析 2017 年该机构实验室处理的培养物，并鉴定出不动杆菌属、假单胞菌属和克雷伯氏菌属阳性的培养物。根据临床实验室标准化协会的指南评估美罗培南药敏试验的抗生素图。
三种 GNB 中不动杆菌属的流行率最低，不同感染部位不动杆菌属对美罗培南的耐药率从 36%（血液）到 82%（呼吸道）不等。假单胞菌属在呼吸道（31%）中高度流行，直肠拭子样本对美罗培南的耐药率较高（71%），但在感染部位的频率相对较低（皮肤/软组织，13%；血液，25%）。克雷伯氏菌属在 7.5%的血液培养物和 15%的尿液培养物中被鉴定出来，是所有病原体中主要的定植菌，占所有直肠拭子样本的 54%，其中 53%对美罗培南耐药。在感染部位，克雷伯氏菌属对美罗培南的耐药率从 19%（皮肤）到 55%（血管导管）不等。
与国家和国际数据相比，我们医院耐碳青霉烯类 GNB 的流行率相对较低；因此，美罗培南仍然是治疗这些细菌的良好选择。在大多数情况下，可以使用其他对 GNB 有效的抗生素，如头孢他啶、头孢吡肟和哌拉西林他唑巴坦，而美罗培南应保留给败血症患者使用。鉴于定植部位观察到的高耐药率，仍需严格采取接触预防措施。
