RESUMO
Resumen Los plásmidos conjugativos y movilizables son las estructuras extracromosomales de mayor importancia epidemiológica, responsables de la propagación horizontal de múltiples genes de resistencia. En este trabajo, se evaluaron cepas de E. coli y K. pneumoniae para determinar la presencia de plásmidos conjugativos y su relación con la adquisición, estabilización y diseminación de múltiples genes de resistencia. Utilizando ensayos de conjugación, se demostró la presencia de plásmidos conjugativos en el 67% de las cepas analizadas. El análisis del tratamiento con enzimas de restricción demostró que existen cepas bacterianas aisladas en diferentes áreas del mismo hospital que portan plásmidos con idénticos patrones de restricción. Los perfiles de resistencia de las cepas transconjugantes revelaron que se transfirieron determinantes de resistencia contra todas las familias de antibióticos analizadas, evidenciándose la contribución de los plásmidos al fenotipo de múltiple resistencia. Nuestros resultados sugieren que las cepas de E. coli y K. pneumoniae aisladas de pacientes de cuatro centros de salud del área metropolitana han podido adquirir el fenotipo de multirresistencia mediante la adquisición de plásmidos portadores de múltiples genes que codifican resistencia a diversos agentes antimicrobianos.
Abstract Conjugative and movable plasmids are the extra chromosomal structures of greater epidemiological importance, responsible for the horizontal propagation of multiple resistance genes. In this study we evaluated E. coli and K. pneunoniae strains to determine the presence of conjugative plasmids and their relationship with the acquisition, stabilization and dissemination of multiple resistance genes. Using conjugation assays we demonstrated the presence of conjugative plasmids in 67% of the strains analyzed. The analysis of restriction enzyme treatments demonstrated that there were bacterial strains isolated from different hospital areas with identical restriction patterns. The resistance profiles of the transconjugating strains revealed that there was transfer of resistance determinants against all the antibiotic families analyzed, demonstrating the plasmid contribution to the multiple resistance phenotype. Our results suggest that the E. coli and K. pneumoniae strains isolated from patients in four health centers of the metropolitan areas may have acquired the multi resistance phenotype through the acquisition of plasmids that bear multiple genes that codify resistance to various antimicrobial agents.
RESUMO
Objetivos. Estudar a freqüência, os fatores de risco e perfil microbiológico das úlceras de pressão dos pacientes neurocirúgicos do Hospital de Base do Distrito Federal. Métodos. Estudo transversal, realizado de 7 a 11 de março de 2005, durante o qual realizou-se busca ativa de pacientes com úlceras de pressão entre os pacientes internados na Unidade de Neurocirurgia do Hospital de Base. Analisou-se, então, nos pacientes portadores de úlcera de pressão, os fatores de risco, a cultura e o antibiograma das amostras das lesões. Resultados. Dos 81 pacientes neurocirúrgicos restritos ao leito, 11 (13,5%) apresentaram úlceras de pressão. A unidade de terapia intensiva apresentou a maior freqüência entre os setores (33,3%). Os fatores de risco encontrados foram: anemia em oito pacientes e distúrbio nutricional em oito. Havia quatro pacientes com traumatismo cranioencefálico e três com traumatismo raquimedular. Apuraram-se 16 casos de úlceras, com maior prevalência nos pacientes com acometimento encefálico. Houve maior prevalência de Klebsiella pneumoniae, Acinetobacter baumannii e Pseudomonas aeruginosa nas culturas, com relevante resistência antimicrobiana a antibióticos de última geração. Conclusão. A freqüência das úlceras de pressão na Unidade de Neurocirurgia do Hospital de Base é semelhante aos descrito na literatura. Os pacientes mais susceptíveis são aqueles que têm comprometimento encefálico, passagem pela UTI, sobrepeso, longa internação e anemia. As bactérias mais freqüentes nas lesões foram Klebsiella pneumoniae, Acinetobacter baumannii e Pseudomonas aeruginosa.
Objective. To study the prevalence of the pressure ulcers, risk factors and microbiological profile of the neurosurgical patients at the Hospital de Base do Distrito Federal. Methods. It deals qith a transversal study, made from 2005 March 7 to 11 at the Department of Neurosurgery of Hospital Base (DNHB). There was na active search for patients with pressure ulcers. A number of patients were evaluated in relation to risk factors of pressure ulcers. Cultures and antibiograms were made from samples of the ulcers. Results. Among 81 bedridden neurosurgical patients, 11 showed pressure ulcers, with mean prevalence of 13.6% in the DNHB. The Intensive Care Unit showed the highest prevalence between de sectors (33,33%). Among the 11 patients with ulcer, 8 patients were anemic and 8 had a nutritional disturbance. Four patients had brain injury from trauma and 3 had spine injury from trauma. We studied 16 patients with ulcers, with the highest prevalence in patients with brain injury. The klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa were the most prevalent bactéria on cultures and they showed na important antimicrobial resistance for the last generation antibiotics. Conclusion. The pressure ulcers prevalence in the DNBH is compatible with the literature. The patiens more susceptible had brain injury, Intensive Care Unit admission, overweight, log hospitalization and anemia. The most prevalent bactéria were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.