RESUMO
ABSTRACT Introduction: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. Material and methods: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. Results: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. Conclusions: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/genética , Tonsilite/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Tonsilectomia/métodos , Tonsilite/cirurgia , Reação em Cadeia da Polimerase , Estudos Transversais , Eletroforese em Gel de Campo Pulsado , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Antibacterianos/farmacologiaRESUMO
O objetivo deste trabalho foi determinar a frequência e o perfil de susceptibilidade a antimicrobianosde Streptococcus em faringotonsilite aguda recorrente. Para o estudo foram coletadas tonsilas de122 pacientes com idade entre 3 e 38 anos (66 pacientes do sexo masculino e 56 do sexo feminino)com histórico de faringotonsilite aguda recorrente, associada à hipertrofia tonsilar, e submetidosà tonsilectomia em um hospital escola. Após isolamento e identificação bacteriana, testes deantibiograma foram realizados para determinar o perfil de susceptibilidade a antimicrobianos. Foram isoladas e identificadas 151 amostras bacterianas pertencentes ao gênero Streptococcus.Destas, 41,1 por cento foram identificadas como Streptococcus grupo viridans não hemolítico; 39,1 por cento como Streptococcus grupo viridans a-hemolítico; 7,3 por cento como Streptococcus dos grupos C, F ou G;5,3 por cento como Streptococcus spp. Beta-hemolítico; 4,6 por cento como Streptococcus spp. não hemolítico; 1,3 por cento como Streptococcus spp. grupo a-hemolítico e 1,3 por cento como Streptococcus Beta-hemolíticos do grupo A. Observou-se nos testes de antibiograma resistência aos antibióticos Beta-lactâmicos. É importante omonitoramento da microbiota que coloniza a orofaringe, visto que alguns de seus componentes têmse tornado resistentes aos medicamentos mais utilizados no tratamento das faringotonsilites, o quepode contribuir para os processos de recidiva.
The aim of this study was to determine the frequency and the antimicrobial susceptibility profileof Streptococcus spp. obtained from recurrent acute pharyngo-tonsillitis. For this study, tonsilsfrom 122 patients ranging from 3 to 38 years old (66 males and 56 females) were collected. Allpatients had a history of recurrent acute pharyngo-tonsillitis associated with tonsillar hypertrophyand were submitted for tonsillectomy at a teaching hospital. After isolation and identification,antimicrobial susceptibility tests were performed. A hundred and fifty one isolates of Streptococcusspp. were obtained from tonsils, consisting of 41.06 percent non-hemolytic Streptococcus viridans group,39.07 percent a-hemolytic Streptococcus viridans group, 7.30 percent Streptococcus of C, F or G groups, 5.30 percent beta-hemolytic Streptococcus spp., 4.63 percent non-hemolytic Streptococcus spp., 1.32 percent a-hemolytic Streptococcus spp. and 1.32 percent group A beta hemolytic Streptococcus. Some of the isolates were resistantto beta-lactamic antibiotics. The study showed that components of the oropharynx microbiotapresented resistance to drugs commonly used to treat pharyngo-tonsillitis infections. Correctdiagnosis would improve treatment and could prevent recurrent infections.