Aspectos epidemiológicos, etiológicos e da susceptibilidade aos antimicrobianos de infecções bacterianas de vias aéreas inferiores em um hospital terciário

Abstract

Health-care-related infections (IRAS) represent one of the most important public health problems in the world. Those located in the Lower Respiratory Tract (TRI) are of great importance because of their frequency and associated morbidity, with pneumonia being the most important epidemiologically. The absence of a gold standard for diagnosis, which can be routinely used, the indiscriminate use of antimicrobials, and inadequate empirical treatment are factors that underlie the permanent challenge of correct diagnosis and treatment. This study has the purpose of tracing the epidemiological and etiological profile of the bacterial infections of the TRI of the patients hospitalized in a regional hospital of Juiz de Fora; in addition to the determination of its antimicrobial susceptibility profile, thus aiding in the diagnosis and the implementation of the correct treatment, aiming to reduce the selection of resistant microorganisms through the empirical and indiscriminate use of antimicrobial drugs. We used representative samples of the TRI from patients hospitalized at the Regional Hospital of João Penido, selected from 2014 to 2016. A total of 431 clinical specimens from several hospital wardens were obtained. The patients' ages ranged from 20 days to 95 years, of both sexes. The samples were sent to the laboratory with the requisition of culture, and after qualification by the Gram method, followed by the isolation, identification of the microorganisms and antimicrobial susceptibility profile, according to POPs from the laboratory of clinical analyzes and the one recommended by the CLSI. Of the 431 samples, 45.2% (195/431) were from the UTI, 13.9% (60/431) from the Pediatric UTI, 1.6% (07/431) from the Neonatal UTI, 9.3% (40/431) of the Intermediate Unit, 7.9% (34/431) of the Female Wing, 12.1% (52/431) of the Male wing, 4.6% (20/431) of the Tisiology and 5.3% (23/431) of Pediatrics. Among the samples, 209 were classified as monomicrobial, with the isolation and identification of only one microorganism and 222 as polymicrobial. A total of 732 microorganisms were isolated, 209 in monomicrobial infections and 523 in polymicrobial infections. Pseudomonas aeruginosa was the most isolated microorganism, with 25.9% (190/732), followed by Acinetobacter baumannii with 25.7% (188/732), Klebsiella pneumoniae with 12.4% (91/732), Staphylococcus aureus with 9.2% (67/732), S. maltophilia with 5.9% (43/732) and others with 20.9% (153/732). According to the resistance profile, of the 732 pathogens isolated in the three years studied, 170 (23.2%) presented resistance phenotypes. Among them, ESBL in 109 (64.1%); MRSA at 35 (20.6%), AmpC at 22 (12.9%) and detection of MLSB at 4 (2.4%). The drug susceptibility profile showed multiresistant pathogens in both monomicrobial and polymicrobial isolates. Thus, our data are highly relevant to surveillance systems and raise discussions about strategies for the care, containment, and rational use of chemotherapy.