EPIDEMIOLOGICAL STUDY OF CARBAPENEM - RESISTANT ENTEROBACTERIACEAE ISOLATES FROM PATIENTS AT LONDRINA UNIVERSITY HOSPITAL IN 2017

Resistance to the carbapenems in members of the Enterobacteriaceaecan be caused by a variety of mechanisms, including serine-based or metallo-β-lactamases alone or in combination with porin protein reduction. Klebsiellapneumoniae infections remain a significant challenge associated with morbidity and mortality worldwide. Few antimicrobials retain activity againstCarbapenem-resistant K. pneumoniae. These include aminoglycosides, tigecycline, and the recently approved ceftazidime/ avibactam. In addition, polymyxins including colistin are an important treatment option. The objective of this study was to determine the susceptibility profile and epidemiological data of 360 enterobacteria that presented resistance to carbapenems isolated from clinical materials of patients hospitalized at Londrina University Hospital in 2017. The samples were previously identified by VITEK®2 automated system BioMeriuex. The most frequent bacterium was K. pneumoniae with 281 (78.6%), followed by Enterobacter cloacae 24 (6.6%), Escherichia coli 18 (5%), and another 37 (10.2%). The most clinical samples were urine 180 (50%), tracheal secretion 92 (25.5%), peripheral blood and via catheter 35 (9.7%), inguinal / rectal swabs (8.3%), tissues / soft parts 19 (5.2%) and liquor and liquids 4 (1.1%). The hospital units that presented the highest frequency of enterobacteria with resistance to carbapenems were the female and male wards 272 (75.5%) and among the patients, the male gender was 215 (59.7%). The isolates showed 95% resistance to ertapenem, 79.4% meropenem, 80.4%imipenem and 96.5% resistance to piperacicline / tazobactam.When fluoroquinolones were evaluated, 82.5% of the isolates presented resistance to norfloxacin, 81.9% ciprofloxacin and 64.3% levofloxacin. The aminoglycosides had the following profile, gentamicin 72.6% and amicacin 40.4%. For Sulfamethoxazole / Trimethoprin 81.6% of the isolates were resistant, Tigecycline 43.7% resistance, colistin 24.7%. Nitrofurantoin was evaluated for140 urine isolates with 76.4% isolates showing resistance. For fosfomycin, 24 urinary isolates were tested and the resistance was 16.7%.This study shows that K. pneumoniae was the most frequent microorganism that presented resistance to carbapenems and few antimicrobials retain activity against Carbapenem-resistant Enterobacteriaceae. It also shows the importance of the epidemiological surveillance studies necessary to know the dissemination of resistance mechanisms as well as to carry out the prevention, control of hospital infections and detection of new resistance mechanisms. This study showed the susceptibility profile of enterobacteria isolated at Londrina University Hospital.