Made available in DSpace on 2014-07-29T15:29:09Z (GMT). No. of bitstreams: 1 Dissertacao Rosemary A S Sobrinho.pdf: 331810 bytes, checksum: 90b92fefc7eba79f810a988a776beca0 (MD5) Previous issue date: 2011-05-06 / A urinary tract infection (UTI) is a very common disease and can occur at any age. The vast majority of UTIs is caused by enteric bacteria. The study aimed to identify the etiologic agents most frequently, the profile of antibiotic susceptibility and the factors possibly associated to the UTIs recurrents in women older than 15 years, cared for and / or admitted to the Hospital of the University of Goias. From March to November 2009, were invited and accepted to participate in the study 923 women in this age group and they were interviewed using a questionnaire about demographics data and risk factors for recurrent infections. Escherichia coli was the most frequent agent accounting for 67.9% of the total, followed by Enterobacter sp (6.2%), Klebsiella sp (6.2%), Proteus mirabilis (4.5%), Morganella morganii (4.0 %), Acinetobacter baumannii (2.8%) and Staphylococcus aureus (2.2%). %). E. coli showed higher rates of resistance to ampicillin in 46.7% patients with recurrent infection and 50.0% in infections nonrecurring; amoxicillin/clavulanate (32.6% and 35.7%), trimethoprim-sulfamethoxazole (30,0 and 25,0%, respectively) and 100,0% susceptibility to imipenem and nitrofurantoin in both groups. Enterobacter sp showed greater resistance to ampicillin, amoxicillin/clavulanic, norfloxacin and gentamicin (>88.0%) and greater susceptibility to amikacin, cefepime, imipinem and cephalosporins. Klebsiella sp showed high resistance to ampicillin and amoxicillin / clavulanate (> 60.0%) and greater susceptibility to quinolones (> 60.0%), amikacin and imipenem (100.0%) in both groups. There were no statistically significant differences between the risk for recurrent infection or not assessed for menopause, hypertension, hysterectomy, SEL (Systemic Erythematosus Lupus) and smoking. The only risk factor associated to recurrent infection in patients older than 50 years with diabetes. In this study, there was a greater number of E. coli in UTIs, followed by other enterobacteria such as Enterobacter sp and Klebsiella sp. Among all drugs tested, all the micro-organisms, were resistant generally to penicillins, being the most effective quinolones and carbapenems. / A infecção do trato urinário (ITU) é uma patologia muito frequente, podendo ocorrer em qualquer idade. A grande maioria das ITUs é causada por bactérias entéricas. O estudo teve como objetivos identificar os agentes etiológicos mais frequentes, o perfil de suscetibilidade aos antimicrobianos e os fatores possivelmente desencadeantes associados às ITUs recorrentes em mulheres com idade superior a 15 anos, atendidas e/ou internadas no Hospital das Clínicas da Universidade Federal de Goiás. No período de março a novembro de 2009, foram convidadas e aceitaram participar da pesquisa 923 mulheres nesta faixa etária e entrevistadas por meio de questionário sobre dados demográficos e fatores de risco para infecções recorrentes. Escherichia coli foi o agente mais frequente representando 67,9% do total, seguido por Enterobacter sp (6,2%), Klebsiella sp (6,2%), Proteus mirabilis (4,5%), Morganella morganii (4,0%), Acinetobacter baumanii (2,8%) e Staphylococcus aureus (2,2%). E. coli apresentou taxas maiores de resistência à ampicilina 46,7% nas pacientes com infecção recorrente e 50,0% nas com infecções não recorrentes; amoxilina/ácido clavulânico (32,6% e 35,7%), sulfametoxazol-trimetoprima (30,0 e 25,0%) respectivamente e 100,0% de suscetibilidade para nitrofurantoína e imipenem em ambos os grupos. Enterobacter sp demonstrou maior resistência à ampicilina, amoxicilina/ácido clavulânico, norfloxacina e gentamicina (>88,0%) e maior suscetibilidade à amicacina, cefepime, imipinem e cefalosporinas. Klebsiella sp demonstrou alta resistência para ampicilina e amoxicilina/ácido clavulânico (>60,0%) e maior suscetibilidade às quinolonas (>60,0%), amicacina e imipenem (100,0%) nos dois grupos estudados. Não foram detectadas diferenças estatisticamente significantes entre o risco para infecção recorrente ou não avaliado para menopausa, hipertensão, histerectomia, LES (Lúpus Eritematoso Sistêmico) e tabagismo. O único fator de risco associado à infecção recorrente foi diabetes em pacientes com mais de 50 anos. Neste estudo, verificou-se um maior número de E. coli nas ITUs e incidência bem menor de outras enterobactérias como Enterobacter sp e Klebsiella sp. Entre os antimicrobianos testados todos os micro-organismos foram resistentes, de um modo geral, às penicilinas sendo mais efetivos as quinolonas e carbapenemas.

Background: Urinary tract infection (UTI) is a common bacterial infection that is usually diagnosed by symptoms such as dysuria and frequency, and the golden standard is to take a urine culture to identify bacteria that may cause UTI. This method was founded with the idea that normal urine is sterile, but this is now being questioned because of growing evidence of a urinary microbiota thus giving a new approach to methods for UTI diagnosis. Aim: To identify and re-evaluate findings of bacteria from urine cultures in the ongoing paradigm shift of a potential urinary microbiome, and dysbiosis as a cause for UTI. Materials and Methods: This study used MALDI-TOF MS to identify approximately 250 bacteria isolates that had been cultured by Expanded Quantitative Urine Culture (EQUC) from 162 women with symptoms of cystitis. EQUC had allowed the bacteria to grow in both CO2 and anaerobic conditions, which differs from standard techniques.   Results and Conclusion: Escherichia coli and Enterococcus faecalis dominated the results of most frequently identified bacteria. However, other bacteria were commonly present within the same culture which is traditionally considered as contamination but may now indicate a urinary flora. Anaerobic bacteria – such as Porphyromonas sp. – were also identified, but their connection to UTI is unclear. Lactobacillus sp. – which are associated with a healthy flora in women – were found in urine cultures and often in smaller quantities which could suggest dysbiosis. More research on Lactobacillus sp. and their correlation with UTI is suggested for a more accurate indication of urinary dysbiosis in women.