Prevalência e resistência de bactérias prioritárias em saúde pública: uma retrospectiva de um hospital de ensino

Abstract

Introduction - Antimicrobial resistance (AMR) is a major challenge for global public health in the 21st century. Carbapenem-resistant A. baumannii (CRAB), extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant P. aeruginosa (CRPA), vancomycin-resistant E. faecium (VRE), and methicillin-resistant S. aureus (MRSA) are among the priority pathogens with public health importance according to the World Health Organization (WHO). Objective - To report the prevalence and resistance pattern of priority bacterial pathogens in public health, particularly those classified as high and critical priority, in a retrospective serie of cultures from patients hospitalized at a teaching hospital between 2019 and 2023. Methodology - This is an observational, descriptive, and retrospective study that aimed to describe the prevalence of high and critical priority bacteria according to the WHO at Onofre Lopes Teaching Hospital (HUOL). Data were accessed through MultiR software, applying a time filter to delimit the analysis period. The study included all bed groups, sample types (blood, urine, soft tissue fragments, and cerebrospinal fluid), and included both community-acquired and hospital-acquired strains. Data were extracted and organized for analysis in Microsoft Excel, and descriptive statistics were performed using SPSS IBM software version 30.0. Positive microbiological culture results were included. Samples with only fungal growth and surveillance samples were excluded. Results and Discussion - Between 2019 and 2023, at HUOL, the most prevalent bacterial species considered public health priorities were ESBL-E, CRPA, and MRSA. CRAB and CRPA were primarily isolated from respiratory samples; ESBL-E, CRE, and VRE from urine; and MRSA from blood cultures. For A. baumannii, the global average carbapenem resistance was 17.5%, and multidrug resistance was 46.9%. Among Enterobacterales, carbapenem resistance was 11.2% in 2019, with ESBL-producing strains accounting for 25.2%; by 2022, these rates had risen to nearly 21% for CRE and 32% for ESBL-E. For P. aeruginosa, global carbapenem resistance was 28.8%, with multidrug resistance at 23.7%. E. faecium showed vancomycin resistance in nearly 55% of isolates. Among S. aureus, oxacillin resistance was present in 31.0% of isolates. Conclusion - The data collected at HUOL reveal that ESBL-E, CRE, CRPA, and MRSA are more prevalent in critical care unit and among immunosuppressed patients, such as those in Oncology/Hematology and Renal Transplant units. Gram-negative bacilli such as ESBL-E, CRE, CRAB, and CRPA are the main concerns for Infection Control and Hospital Epidemiology (ICHE) teams in developing countries, due to complications arising from increasing resistance