Resistências bacterianas emergentes em Pseudomonas aeruginosa: uma revisão da literatura

Abstract

Antimicrobial resistance is a growing concern as it poses a threat to global health. Among the microorganisms that cause nosocomial infections, Pseudomonas aeruginosa is one of the most frequent and is associated with occurrences of antimicrobial resistance. The aim of this study was to present an overview of resistance to cephalosporins and carbapenems found in Pseudomonas aeruginosa, through a narrative literary review. Articles were searched in scientific databases using the keywords: Pseudomonas sp, Resistance, Cephalosporin, Carbapenems, KPC, NDM and OXA, and 227 articles were retrieved. Of these, 51 were selected for categorization according to the type of data presented. For complete reading and review, 12 articles were selected. From these it was found that the main resistance mechanisms associated with Pseudomonas aeruginosa are: loss of porins; AmpC overexpression; overexpression of the efflux system; production of serine-𝛽-lactamases of the OXA and KPC type; and production of metallo-𝛽-lactamases of the VIM, IMP and NDM type. The frequency distribution of resistance mechanisms may vary according to geographic location. The KPC enzyme can be found all over the world, VIM-2 is predominant in Europe and, in Brazil, in addition to the metallo-𝛽-lactamases VIM, IMP and NDM, SPM-1 is also frequently found. Among the available methods of detecting these mechanisms, immunochromatographic assays are the most cost-effective and quick to obtain results. Selective chromogenic culture media are also widely used for surveillance cultures. Current therapeutic alternatives for infections caused by multidrug-resistant microorganisms are ineffective, and it is imperative to develop and validate new antimicrobial combinations that are effective against multidrug-resistant microorganisms. In short, the present work analyzed and compiled from the literature which are the resistance mechanisms most associated with Pseudomonas aeruginosa, their geographic distributions and frequencies; the detection methods used to differentiate between such mechanisms; and what treatment options are available. Finally, highlighting the need for further research on resistance surveillance, development and validation of drugs involving multi resistant microorganisms.