Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features.
Helena Ferreira Leal, Jailton Azevedo, Giulyana Evelyn Oliveira Silva, Angelica Maria Lima Amorim, Larissa Rangel Cabral de Roma, Ana Carolina Palmeira Arraes, Edilane Lins Gouveia, Mitermayer Galvão Reis, Ana Verena Mendes, Marcio de Oliveira Silva, Maria Goreth Barberino, Ianick Souto Martins, Joice Neves Reis
Author Information
Helena Ferreira Leal: Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil.
Jailton Azevedo: Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil.
Giulyana Evelyn Oliveira Silva: Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
Angelica Maria Lima Amorim: Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
Larissa Rangel Cabral de Roma: Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
Ana Carolina Palmeira Arraes: São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.
Mitermayer Galvão Reis: Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil.
Ana Verena Mendes: São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.
Marcio de Oliveira Silva: São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.
Maria Goreth Barberino: São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.
Ianick Souto Martins: Faculty of Medicine, Fluminense Federal University Downtown, 24033-900, Niterói, Rio de Janeiro, Brazil.
Joice Neves Reis: Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil. joice@ufba.br. ORCID
BACKGROUND: Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). METHODS: We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. RESULTS: Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. CONCLUSIONS: Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance.
