Prevalência e caracterização molecular de enterobacterales resistentes a carbapenêmicos em pacientes de um hospital público de referência em uma região não metropolitana do Brasil durante e após a pandemia de SARS-CoV-2

Abstract

Antimicrobial resistance (AMR) poses a critical global threat, and CarbapenemResistant Enterobacterales (CRE) are of significant concern due to limited therapeutic options. This retrospective cross-sectional study investigated the prevalence of carbapenemase genes (blaKPC, blaOXA-48, blaNDM, blaVIM, and blaIMP) in CRE strains isolated from tracheal aspirates of patients in a university hospital in the Zona da Mata Mineira region, from January 2020 to August 2023. The identification of bacterial isolates was performed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF), while carbapenemase gene detection was carried out through Real-Time Polymerase Chain Reaction (qPCR). Among the 1,133 analyzed tracheal aspirate samples, 111 (9.79%) showed CRE growth. Following bacterial confirmation and chart analysis, 46 isolates from an equal number of patients were included in the final sample, with a predominance of Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was found in 21.74% of isolates; blaVIM, blaIMP, and blaOXA-48 genes were not identified. Demographic and hospital data analysis revealed a predominantly male (67.39%), elderly (69.57%), self-declared white (56.52%), unmarried (63.04%), and low-educated population (56.52%). The majority of patients (69.57%) were admitted to the Intensive Care Unit and remained hospitalized for more than 30 days (76.08%). COVID-19 infection was documented in 34.78% of the cases. Statistical analysis revealed a significantly inverse trend between Klebsiella pneumoniae prevalence and age group (p = 0.045) and a direct linear trend between proportions of CRE carrying the blaNDM gene and the annual trend of new COVID-19 cases in Brazil (p = 0.050). Furthermore, this study found a significantly higher probability of encountering Non-Klebsiella pneumoniae bacteria in patients with prolonged hospital stay, regardless of COVID-19 status (p = 0.006) and type of resistance gene (p = 0.020). This study underscores the persistent prevalence of CRE, particularly those with the blaKPC gene, supporting health surveillance actions and advocating for public policies with control measures to address AMR, a crisis that can be considered one of the greatest global pandemics.