Perfil de susceptibilidade de Klebsiella sp. e otimização de antibioticoterapia baseado no Antimicrobial Stewardship Program: um estudo transversal.

Abstract

Faced with the spread of multidrug-resistant organisms (MDRO), with Klebsiella sp. being a pathogen of great clinical and epidemiological importance, the World Health Organization (WHO) encourages the implementation and optimization of the interventions provided for in the Antimicrobial Stewardship Program (ASP). Considering the need to adapt programs according to local epidemiology, this study aims to propose a bundle provided in the ASP to optimize the use of antimicrobials based on the local epidemiology of Klebsiella sp. To this end, a cross-sectional study was carried out in a teaching hospital with activities provided for in the PGA under implementation. The data collected retrospectively was analyzed from August 2019 to July 2023. Biological samples of Klebsiella sp. were collected from various infection sites. Susceptibility tests were carried out using a computerized system, VITEK® 2 compact. According to the susceptibility profile found, the samples were defined as multisensitive Klebsiella sp. (MS-K.sp), carbapenem-resistant (CR-K.sp), and extended-spectrum β-lactamase (ESBL-K.sp) producers. Based on the epidemiological data on incidence and relative frequency found, actions were proposed to optimize the use of antimicrobials, an essential component of the ASP. As a result, 2210 specimens were analyzed, predominantly Klebsiella pneumoniae (93%). Of the total specimens, 40% were defined as CR-K.sp and 52% as ESBL-K.sp, with co-expression of resistance genes. Peaks in the time series were identified during 2020 and 2021 for both the incidence of pathogens and resistance to the susceptibility antimicrobials tested. Amikacin, tigecycline, and polymyxin showed lower frequencies of resistance among the CR-K.sp. and ESBL-K.sp. specimens. In MS-K.sp. an increase in the incidence of resistance to ciprofloxacin, amoxicillin/clavulanate, and sulfamethoxazole/trimethoprim was identified. The urinary tract was the main site of infection with a predominance of MS-K.sp and blood specimens showed high frequencies of MDRO. Given the epidemiologic data on K. sp, critical points were defined and targeted for interventions based on what was proposed by the PGA. To prioritize the use of amikacin as an aminoglycoside, changes in facility-specific treatment guidelines were proposed to help reduce the identification of MDRO in blood specimens and umbilical and central catheters, intensification of activities related to the change from intravenous to oral therapy was proposed, as well as the implementation of "handshake" stewardship to reduce the spread of CR-K.sp and ESBL-K.sp, among other interventions. It can be concluded that knowledge of the local epidemiology of microorganisms and their resistance profiles is important for the development of targeted interventions to optimize institutional PGA and achieve the goal of reducing the spread of MDROs.