Prevalência de uropatógenos e sensibilidade antimicrobiana em uroculturas de gestantes do Sul do Brasil / Microbial etiology and susceptibility of community urinary tract infections during pregnancy in the south of Brazil

OBJETIVO: O objetivo do estudo foi avaliar a prevalência de germes e do perfil de sensibilidade a antimicrobianos a partir de uroculturas de pacientes gestantes atendidas em um hospital materno-infantil em Porto Alegre, Brasil. MÉTODOS : Foi realizado estudo transversal, retrospectivo e descritivo, no Hospital Fêmina, referência para atendimento às mulheres durante o pré-natal, parto e puerpério na cidade de Porto Alegre, Brasil. A partir de 1.558 uroculturas positivas, foram avaliados 482 resultados microbiológicos comunitários com perfil de sensibilidade antimicrobiana de uroculturas de gestantes em todas as idades gestacionais, atendidas no período de janeiro de 2007 a julho de 2013. RESULTADOS : O padrão de sensibilidade apresentado nesta pesquisa mostra que a escolha para o tratamento de infecção urinária durante a gravidez deve ser nitrofurantoína (para infecções não complicadas) ou cefalosporinas de segunda geração, como cefuroxima (para infecções não complicadas e complicadas), evitando o uso de ampicilina, cefalosporinas de primeira geração e sulfametoxazol/trimetoprim. CONCLUSÃO : O tratamento empírico de infecção urinária na gravidez deve ser iniciado de acordo com os padrões de suscetibilidade descritos na literatura, e revisto após os resultados de cultura de urina. .

PURPOSE : Urinary tract infection (UTI) is one of the most common conditions during pregnancy. The aim of this study was to assess the prevalence of germs and the antimicrobial susceptibility profile in urine culture isolates from pregnant patients treated at a tertiary maternity hospital in Porto Alegre, Brazil. METHODS : A cross-sectional, retrospective and descriptive study was carried out at Hospital Fêmina, a leading institution in prenatal, birth and postnatal healthcare in the city of Porto Alegre, Brazil. A total of 482 microbial community results were analyzed out of 1,558 positive urine cultures of pregnant women in all gestational ages treated at Fêmina Hospital between January 2007 and July 2013. RESULTS: The susceptibility pattern presented in this research shows that the choice for UTI treatment during pregnancy should be nitrofurantoin (for uncomplicated infections) or second-generation cephalosporins such as cefuroxime (for uncomplicated and complicated infections), over ampicillin, first-generation cephalosporins and sulfamethoxazole/trimethoprim. CONCLUSION : Empirical treatment for UTI in pregnancy should be started according to the susceptibility patterns described in the literature and re-analyzed after the results of the urine culture. .

Patrones de resistencia bacteriana en urocultivos en un hospital oncológico / Antimicrobial resistance patterns of isolates from urine cultures at an oncological center

OBJETIVOS: Describir los patrones de resistencia bacteriana en cultivos de orina en un hospital oncológico. MATERIAL Y MÉTODOS: Se incluyeron las cepas obtenidas de cultivos de orina de 1998 a 2005. Se obtuvo el porcentaje de sensibilidad para diferentes antibióticos, tras analizar por separado cepas nosocomiales y compararlas con las de la comunidad. RESULTADOS: Se detectaron 9 232 cultivos positivos (20.7 por ciento) de 44 447 muestras: gramnegativos, 78.8 por ciento; grampositivos, 13.8 por ciento; y levaduras, 7.4 por ciento. Escherichia coli fue el principal microorganismo identificado (41.3 por ciento); la resistencia en aislados nosocomiales fue mayor que en la comunidad para amikacina (92.4 y 97 por ciento), ceftazidima (83.1 y 95.1 por ciento) y ciprofloxacina (46.2 y 58.6 por ciento). De igual manera, Pseudomonas aeruginosa presentó mayor resistencia para amikacina y ceftazidima en las cepas nosocomiales (55.7 y 66.6 por ciento; y 65.5 y 84.8 por ciento, respectivamente). Enterococcus resistente a vancomicina se encontró sólo en 2.5 por ciento (3/119 aislados de E. faecium). CONCLUSIONES: Existe una mayor resistencia bacteriana en las cepas de origen nosocomial en comparación con las cepas comunitarias. Se encontró un incremento progresivo de la resistencia para E. coli, el patógeno aislado con más frecuencia de infecciones nosocomiales y comunitarias. Es prioritario intensificar una campaña educativa para el control y uso racional de los antibióticos.

OBJECTIVE: To describe the patterns of antimicrobial resistance of organisms isolated from urine cultures at a teaching oncological hospital for adult patients. MATERIAL AND METHODS: All strains obtained from urine cultures from 1998 to 2005 were included. Mean susceptibilities were obtained for each antimicrobial tested; nosocomial and community-acquired isolates were analyzed separately. RESULTS: A total of 9 232 positive urine cultures were obtained (20.7 percent) from 44 447 samples taken. Gram negative bacteria were reported in 78.8 percent, Gram-positive in 13.8 percent and yeasts in 7.4 percent. Escherichia coli was the most frequently isolated bacterium (41.3 percent); antimicrobial resistance was higher in nosocomial isolates than in community strains (amikacin 92.4 vs. 97 percent, ceftazidime 83.1 vs. 95.1 percent and ciprofloxacin 46.2 vs. 58.6 percent). Pseudomonas aeruginosa showed a greater resistance to amikacin and ceftazidime in nosocomial cultures compared to community-acquired bacterial cultures (55.7 vs. 66.6 percent and 65.5 vs. 84.8 percent respectively). Vancomycin-resistant enterococci were found in only 2.5 percent (3 of 119 E. faecium isolates). CONCLUSIONS: Higher bacterial resistance was observed in nosocomial cultures than in community ones. Antimicrobial resistance was found to be progressively increasing for E. coli, the most frequent pathogen isolated both in nosocomial and community infections. We consider imperative the establishment of an intense educational campaign for the use and control of antibiotics.