Estudo da susceptibilidade a antimicrobianos da Neisseria gonorrhoeae isolada de pacientes atendidos em centro referencial público para doenças sexualmente transmissíveis de Belo Horizonte

Abstract

Gonorrhea, even today, continues to represent a big public health concern, with serious consequences, especially for women and children. Occur each year 106 million new cases of gonorrhea in the world. Its control has been difficult in most populations, and it remains as an example of the influence of social, behavioral and demographic factors about the epidemiology of the infectious disease. The treatment of gonorrhea has passed through modifications imposed by changes in the molecular structure of the gonococcus, mediated by chromosomes or plasmids, which gives it the ability to resist to the action of various antibiotics, such as penicillins, tetracyclines, macrolides, quinolones, thiamphenicol, spectinomycin, and recently, cephalosporins. The knowledge of local Neisseria gonorrhoeae susceptibility patterns is essential to establish the best treatment. The gonococcal infection resistance requires a quality continuous surveillance, however few studies on this topic have been conducted in Brazil. In this study, was sought the evaluation of the antimicrobial susceptibility of N. Gonohrroea isolated from patients treated at the service of reference for sexually transmitted diseases and infectology (STD / SAE) - Center-South Secondary Reference Unity, of the Municipal Health Secretary (URS-CS/SMSA) of Belo Horizonte; determine the frequency of gonorrhea in the health unit and to determine the socio-demographic characteristics of the patient attended in the service in relation to age, gender, income, place of residence, education, number of sex partners, historic of sexually transmitted disease and condom use. Between 2011 March and 2012 February were obtained consecutively, 201 Neisseria gonorrhoeae isolates in men with symptoms of urethritis and symptomatic women or in initial consultation. After confirmatory identification of microorganism strains were tested by disk diffusion and minimum inhibitory concentration determined by Etest to azithromycin, cefixime, ceftriaxone, ciprofloxacin, chloramphenicol, penicillin, tetracycline and spectinomycin. Were performed serologies for hepatitis B and C, human immunodeficiency virus, syphilis and microscopies for the diagnosis of other STDs. Information was obtained on socio-demographic and behavioral characteristics of patients using a questionnaire and medical records. It was observed sensitivity of 100,0% of the isolates to cefixime, ceftriaxone and spectinomycin. The observed resistance was 4.5% (9/201), 21.4% (43/201), 11.9% (24/201), 22.4% (45/201), and 32.3% (65/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Reduced sensitivity was observed in 17.9% (36/201), 4.0% (8/201), 16.9% (34/201), 71.1% (143/201) and 22.9% (46/201) to azithromycin, ciprofloxacin, chloramphenicol, penicillin and tetracycline, respectively. Them were classified as plasmid-mediated resistance to penicilin(PPNG) 14.5% (29/201), and tetracycline (TRNG) 9.5% (19/201). The high resistance detected percentage to penicillin, tetracycline, ciprofloxacin and chloramphenicol make them unsuited to the treatment of gonorrhea in the Health Unit, and possibly in all Belo Horizonte. The rates of resistance and reduced susceptibility recommend caution in the use of azithromycin, besides emphasizing the need of establish mechanisms for surveillance of antimicrobial resistance for effective control of gonorrhea.