Resistência aos carbapenêmicos em enterobactérias: avaliação de superfícies inanimadas em hospitais da cidade de Manaus

Abstract

The infections related with health assistance are responsible in resume for the hospitalized patients‘ immunological, physical and mental commitment. In all the ways of nosocomial infections acquisition, the inanimate surfaces are indicated as responsible by the microorganism intersected contaminations presents at these surfaces to these patients. The majority of these agents produce mechanisms responsible by the resistance with a large quantity of antibiotics. The enterobacterias are the most common in hospital infections, with the production of ESβL against the β-lactaminics and carbapenamasis against carbapenemics. With the goal of evaluate the presence of enterobacterias in hostpital surfaces, as well the profile of resistance to antibiotics and possible production of resistance enzyme, this project were realized in hospital inanimate surfaces of two local hospitals: HUGV and ICAM. The evaluated surfaces were infirmary‘s sinks and bed and mattress‘ lateral structure, with isolation and identification of the recovered samples from these surfaces, antibiotics sensibility profile evaluation, phenotypic tests to detect the production of the enzyme and molecular characterization to evaluate the enzymes produced. As results, were recovered 23 isolated of enterobacteria at HUGV and 33 at ICAM, with the prevalence of species of Enterobacter and Klebsiella. The samples showed resistance against first generation penicillin and cephalosporin, over well other classes, and sensibility to carbapenemics. Fourteen samples were classified as producers of ESβL and one sample presented a resistance profile to carbapenemics, confirmed by molecular methods. The most founded enzymes were TEM, SHV and CTX-M-1/2. One isolated of k. pneumoniae were identified as KPC producer. Three samples from HUGV and two samples from ICAM showed 100% of similarity. The results of this project contribute with the local epidemiology, emphasizing the importance of the implementation of better hygiene and sanitization conditions. The premature identification of the β-lactamases/carbapenemases producers not only in clinical infections, but also in colonization state are vital to prevent difficulty and impossibility to treat infections, in consequence of the reduction of antibiotics release in the market.