Perfil e evolução de resistência à β-lactâmicos e à vancomicina em Staphylococcus aureus isolados de hemoculturas
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Data
2023-02-07
Autores
Brenno, Guilherme de Lima
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Continuamos a falhar na contenção da propagação de genes de resistência, que já representam uma ameaça à saúde das populações. Atualmente, micro-organismos multidroga-resistentes já são responsáveis por quadros infecciosos adquiridos na comunidade. Exemplo importante são os MRSA (Methicillin-resistant Staphylococcus aureus), que representam grave risco à saúde pública em todo o mundo, devido à rápida propagação e diversificação de clones pandêmicos com resistência antimicrobiana cada vez maiores. MRSA são uma das principais causas de infecções nosocomiais ou relacionadas à assistência à saúde (Healthcare-associated [HA]-MRSA), e sua prevalência vem crescendo nas infecções associadas à comunidade (Community-associated [CA]-MRSA). MRSA é gerado quando S. aureus sensível à meticilina (MSSA) adquire por via exógena o gene de resistência à meticilina, mecA, transportado por um elemento genético móvel, cassete cromossômico estafilocócio mec (SCCmec). A resistência em S. aureus não se restringe à meticilina e demais β-lactâmicos. Nos últimos anos, tem sido observado aumento lento e progressivo da resistência de baixo nível à vancomicina, levando a falha no tratamento de MRSA. Há também aumento no relato de S. aureus intermediariamente sensível ou mesmo resistente à vancomicina. Atualmente, os medicamentos recentemente desenvolvidos como as cefalosporinas de 5ª geração podem tratar esses estafilococos resistentes, porém já existem relatos de sensibilidade reduzida aos mesmos. Tendo em vista a rápida aquisição de resistência e o alto índice de infecções e de mortalidade causados por estes micro-organismos, torna-se imprescindíveis estudos com número significativo de amostras e que abranjam longos períodos para avaliar a evolução de resistência para controle e terapêutica adequada. Assim sendo, o estudo teve por objetivo caracterizar o perfil e a evolução de resistência à ꞵ-lactâmicos e à vancomicina em S. aureus isolados de hemoculturas, bem como a resistência à ceftarolina (cefalosporina de quinta-geração). Foram analisados 184 isolados entre o período de 2014 a 2022, sendo 117 (63,6%) MSSA e 67 (36,4%) MRSA. Dentre os MRSA, 10 se apresentaram como OS-MRSA. Diante dos achados, conclui-se que a detecção de OS-MRSA no ambiente hospitalar é desafiadora, visto que se deve aliar métodos de identificação fenotípica e genotípica, e que se deve investigar mais amplamente a epidemiologia destes micro-organismos.
We continue to fail to contain the spread of resistance genes, wich already pose a threat to the health of populations. Currently, multidrug-resistant microorganisms are already responsible for infectious conditions acquired in the community. An important example is MRSA (Methicillin-resistant Staphylococcus aureus), which represent a serious risk to public health worldwide, due to the rapid spread and diversification of pandemic clones with increasing antimicrobial resistance. MRSA are one of the main causes of nosocomial or healthcare-associated infections (Healthcare-associated [HA]-MRSA), and their prevalence is increasing in community-associated infections (Community-associated [CA]-MRSA). MRSA is generated when methicillin-sensitive S. aureus (MSSA) exogenously acquires the methicillin resistance gene, mecA, carried by a mobile genetic element, staphylococcal chromosomal cassette mec (SCCmec). Resistance in S. aureus is not restricted to methicillin and other β-lactams. In recent years, a slow and progressive increase in low-level resistance to vancomycin has been observed, leading to failure in the treatment of MRSA. There is also an increase in reports of S. aureus intermediately sensitive or even resistant to vancomycin. Currently, newly developed drugs such as 5th generation cephalosporins can treat these resistant staphylococci, but there are already reports of reduced sensitivity to them. In view of the rapid acquisition of resistance and the high rate of infections and mortality caused by these microorganisms, studies with a significant number of samples and covering long periods are essential to evaluate the evolution of resistance for control and adequate therapy. Thus, the study aimed to characterize the profile and evolution of resistance to ꞵ-lactams and vancomycin in S. aureus isolated from blood cultures, as well as resistance to ceftaroline (fifth-generation cephalosporin). A total of 184 isolates were analyzed between 2014 and 2022, 117 (63.6%) MSSA and 67 (36.4%) MRSA. Among the MRSA, 10 presented themselves as OS-MRSA. In view of the findings, it is concluded that the detection of OS-MRSA in the hospital environment is challenging, since phenotypic and genotypic identification methods must be combined, and that the epidemiology of these microorganisms must be investigated more widely.
We continue to fail to contain the spread of resistance genes, wich already pose a threat to the health of populations. Currently, multidrug-resistant microorganisms are already responsible for infectious conditions acquired in the community. An important example is MRSA (Methicillin-resistant Staphylococcus aureus), which represent a serious risk to public health worldwide, due to the rapid spread and diversification of pandemic clones with increasing antimicrobial resistance. MRSA are one of the main causes of nosocomial or healthcare-associated infections (Healthcare-associated [HA]-MRSA), and their prevalence is increasing in community-associated infections (Community-associated [CA]-MRSA). MRSA is generated when methicillin-sensitive S. aureus (MSSA) exogenously acquires the methicillin resistance gene, mecA, carried by a mobile genetic element, staphylococcal chromosomal cassette mec (SCCmec). Resistance in S. aureus is not restricted to methicillin and other β-lactams. In recent years, a slow and progressive increase in low-level resistance to vancomycin has been observed, leading to failure in the treatment of MRSA. There is also an increase in reports of S. aureus intermediately sensitive or even resistant to vancomycin. Currently, newly developed drugs such as 5th generation cephalosporins can treat these resistant staphylococci, but there are already reports of reduced sensitivity to them. In view of the rapid acquisition of resistance and the high rate of infections and mortality caused by these microorganisms, studies with a significant number of samples and covering long periods are essential to evaluate the evolution of resistance for control and adequate therapy. Thus, the study aimed to characterize the profile and evolution of resistance to ꞵ-lactams and vancomycin in S. aureus isolated from blood cultures, as well as resistance to ceftaroline (fifth-generation cephalosporin). A total of 184 isolates were analyzed between 2014 and 2022, 117 (63.6%) MSSA and 67 (36.4%) MRSA. Among the MRSA, 10 presented themselves as OS-MRSA. In view of the findings, it is concluded that the detection of OS-MRSA in the hospital environment is challenging, since phenotypic and genotypic identification methods must be combined, and that the epidemiology of these microorganisms must be investigated more widely.
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Palavras-chave
Staphylococcus aureus, MRSA, OS-MRSA, Staphylococcus aureus resistente à meticilina, Anti-infecciosos, Infecção hospitalar, Pacientes hospitalizados - Exames médicos, Saúde pública