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Previous issue date: 2015-05-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / As Infec??es Hospitalares (IH) se constituem na principal causa de morbidade e mortalidade em pacientes hospitalizados. Relatos de isolamentos de Acinetobacter multirresistentes a partir de esp?cimes cl?nicos obtidos de pacientes internados bem como do ambiente hospitalar s?o cada vez mais frequentes. Assim, esse projeto tem como objetivo caracterizar fenotipica e molecularmente, isolados de Acinetobacter spp. quanto ? susceptibilidade aos antimicrobianos. Os isolados de Acinetobacter foram coletados em quatro hospitais localizados na cidade do Natal-RN, no per?odo de 2013 a 2014. A identifica??o dos isolados foi realizada atrav?s de provas laboratoriais convencionais, atrav?s do sistema MALDI-TOF e atrav?s da pesquisa do gene blaOXA51. A susceptibilidade aos antimicrobianos foi avaliada pela metodologia de disco-difus?o. Para a droga tigeciclina, a concentra??o inibit?ria m?nima (CIM) foi determinada atrav?s do E-test . Al?m disso, foram realizados testes de triagem para as enzimas AmpC, ESBL e Carbapanemases e pesquisa dos genes para as carbapenemases (IMP-1, VIM-1, NDM-1, KPC-2, OXA-23,OXA-24,OXA-58,OXA-143), atrav?s da t?cnica da Rea??o em Cadeia da Polimerase (PCR). N?o houve 100% de concord?ncia entre os resultados obtidos pelas t?cnicas utilizadas para a identifica??o dos isolados. 90% e 81,8% das amostras foram identificadas como A.baumannii pelos testes convencionais e MALDI-TOF, respectivamente e a positividade do blaOXA51 aconteceu em 97,1% das amostras . No ambiente hospitalar, os locais mais contaminados por essa esp?cie foi a bancada de procedimentos e o piso. A maioria (58,2%) das cepas de Acinetobacter apresentaram resist?ncia ? tr?s ou mais classes de antibi?ticos. A positividade no teste para detec??o de AmpC foi de 5,8%, no Teste de Hodge foi de 61,1% e para o teste de detec??o de Metallo-?-lactamase foi de 78,5%. Nenhuma amostra se mostrou produtora de ESBL. Os genes mais encontrados, al?m do blaOXA51 foram o blaOXA23 e blaOXA143. A m?dia da preval?ncia de Acinetobacter nos hospitais estudados foi de 7,6% em amostra cl?nicas e de 12,8% nas amostras do ambiente hospitalar, a sazonalidade foi demonstrada e v?rios fatores relacionados com a multirresist?ncia foram estatisticamente relevantes. O elevado n?mero de Acinetobacter multirresistente aos antimicrobianos, isolados a partir de pacientes e sobretudo das superf?cies inanimadas dos hospitais ? preocupante. Esse cen?rio pode comprometer tanto os tratamentos emp?ricos de pacientes em estado grave quanto ?s estrat?gias de controle de infec??o hospitalar. / The Hospital Infections are the main cause of morbidity and mortality in hospitalized patients. Isolations reports of multidrug-resistant Acinetobacter from clinical specimens obtained from hospitalized patients and the hospital are more frequent. Thus, this study aimed to characterize molecular and phenotypic isolated from Acinetobacter sp. for susceptibility to antimicrobials, with emphasis on ?-lactams. Clinical isolates and hospital surfaces isolates of Acinetobacter sp. were collected in four hospitals located in the city of Natal-RN, from March 2013 to March 2014. The identification of the isolates was carried out by standard laboratory tests, the MALDI-TOF system and research blaOXA-51 gene. The antimicrobial susceptibility was evaluated by disk diffusion method. For tigecycline drug, the minimum inhibitory concentration (MIC) was determined by the E-test. Furthermore, screening tests were performed for AmpC enzymes, and ESBL Carbapanemases and research of genes for carbapenemases (IMP-1, VIM-1, NDM-1, KPC-2, OXA-23, OXA-24, OXA- 58, OXA-143) by technique of polymerase chain reaction (PCR). Factors associated with the presence of multidrug resistance were also studied. 242 samples were studied, with 155 clinical samples and 87 samples of hospital surfaces. The mean occurrence of Acinetobacter sp. in the hospitals studied was 7.6% in clinical sample and 12.8% in samples of hospital surfaces. In this, the sites most contaminated by this bacterium was the bench procedures and the floor. Two hundred and thirty seven samples (97.9%) and 198 (81.8%) of the samples were identified as A.baumannii by conventional tests and MALDI-TOF, respectively, and the positivity of blaOXA-51 gene occurred in 235( 97.1%) samples. Most, 141 (58.2%) of the strains of Acinetobacter sp. They were resistant to three or more classes of antibiotics. A positive test for the detection of enzyme AmpC were 5.8% in Test Hodge was 61.1% and the ?-lactamase Metallo was 78.5% detection test. No samples proved producing ESBL. The genes most commonly found were the blaOXA-23 and blaOXA-143. The use of invasive devices (p = 0.001), the amount of antimicrobials used (p = 0.01), the ICU stay (p = 0.008) and hospitalization in a public hospital (p = 0.05) presented themselves as factors associated with the acquisition of Acinetobacter sp. strains MDR. Death was the most frequent clinical outcome (p <0.001) in patients with infection by these strains. The high number of multidrug-resistant Acinetobacter antimicrobial, isolated from patients and especially of inanimate surfaces in hospitals is disturbing. This scenario may compromise both the empirical treatment of seriously ill patients as the hospital infection control strategies.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/20483 |
| Date | 14 May 2015 |
| Creators | Lopes, Maria Carolina Soares |
| Contributors | 34195602300, http://lattes.cnpq.br/0580551464788795, Motta Neto, Renato, 46132252304, http://lattes.cnpq.br/6909091962347443, Almeida, Gilmara Celli Maia de, 01172416443, http://lattes.cnpq.br/5694096571543495, Melo, Maria Celeste Nunes de |
| Publisher | Universidade Federal do Rio Grande do Norte, PROGRAMA DE P?S-GRADUA??O EM CI?NCIAS BIOL?GICAS, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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