Epidemiologia molecular de Beta-lactamases de espectro estendido (ESBL) e carbapenemase KPC produzidas por enterobactérias isoladas de pacientes de Alagoas

Abstract

Bacterial resistance is one of the worldwide public health issues. This work aimed to genetically characterize species of the family Enterobacteriaceae phenotipic producing ESBL and KPC obtained from patients of Alagoas. Bacteria were identified by semi-automated tests. Confirmed as producing ESBL and KPC by phenotypic screening tests. The antimicrobial in vitro susceptibility test was performed by disk-diffusion method. DNA was extracted by boiling method at 95ºC. The resistance genes blaTEM, blaCTX-M, blaSHV e blaKPC were identified with specific primers and genetic typing was performed by PCR with the microsatellite (GTG)5. 254 isolates of enterobacteria were obtained, of which 92,12% (234/254) had some of the genes blaTEM, blaCTX-M, blaSHV or blaKPC, 87,18% (204/234) ESBL (blaTEM, blaCTX-M, blaSHV) and 12,82% (30/234) KPC (blaKPC). Of these 234 isolates, 4,7% (11/234) were community-acquired infections with genes that express ESBL and 95,3% (223/234) of hospital infections, of which 86,55% (193/223) ESBL and 13,45% (30/223) KPC. BlaCTX-M (> 80%) was the most frequent type gene in enterobacteria. Urinary infections were the most frequent cases of infection in the community by Escherichia coli (54,55%) and Klebsiella pneumoniae (39,46%) in the hospital. BlaKPC was identified only in bacteria of hospital infections, especially in K. pneumoniae (30%). At the ICUs (38,57%) were obtained the most number of isolates producing ESBL and KPC. These enterobacteria showed multidrug resistance phenotypes with high levels for aminoglycosides, fluoroquinolones and sulfamethoxazole/trimethoprim. Associations between genotypes and antibiotic resistance were observed. Cases of clonal spread were identified in the hospital of Alagoas by enterobacteria producing ESBL and KPC. There is a predominance of genes blaTEM, blaCTX-M, blaSHV and blaKPC among isolates of enterobacteria resistant to beta-lactam, with the prevalence of the genetic element blaCTX-M. The clonal spread have contributed to the high levels of beta-lactam resistance among isolates of enterobacteria at hospitals in this study.