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Sensibilidade das enterobacteriáceas produtoras de beta-lactamases de espectro alargado à fosfomicina
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Advisor(s)
Abstract(s)
Introdução: A emergência de enterobacteriáceas produtoras de
beta-lactamases de espectro alargado (ESBL) nos últimos anos representa
um problema de saúde pública, escasseando alternativas
eficazes para o seu tratamento. Vários trabalhos internacionais têm
demonstrado uma sensibilidade in vitro muito elevada destas bactérias
à fosfomicina, havendo alguns que testaram a eficácia clínica
do tratamento de cistites agudas não complicadas no subgrupo
das Escherichia coli com resultados promissores. No Hospital Prof.
Dr. Fernando Fonseca EPE (HFF) tem havido um aumento anual
progressivo do isolamento destes patogéneos. Os autores pretenderam
testar a sensibilidade das enterobacteriáceas produtoras de
ESBL à fosfomicina no HFF e averiguar o eventual potencial terapêutico.
Material e métodos: Estudo prospectivo, durante 6 meses, no qual
foi testada a sensibilidade à fosfomicina das enterobacteriáceas produtoras
de ESBL isoladas. Foi utilizado o equipamento VITEK 2® para
identificação das estirpes. A susceptibilidade à fosfomicina foi determinada
através do método de difusão de disco (Oxoid®). O tratamento
estatístico foi realizado através do programa Microsoft Excel®.
Resultados: Foram identificadas 150 enterobacteriáceas ESBL,
das quais 52% corresponderam a Klebsiella pneumoniae e 44%
a Escherichia coli. Cerca de 88% das Escherichia coli e 68% das
Klebsiella pneumoniae apresentaram sensibilidade à fosfomicina.
Conclusões: De acordo com os dados obtidos a nível internacional
e no nosso hospital, os autores recomendam a utilização da
fosfomicina para tratamento de cistites agudas não complicadas
provocadas por Escherichia coli produtoras de ESBL, sugerindo,
concomitantemente, a realização de trabalhos futuros de eficácia
clínica para consubstanciar esta prática e recomendação.
Introduction: The rising frequency of extended spectrum Beta-lactamase (ESBL) producing Enterobacteriaceae in recent years represents an important public health issue, with scarce effective alternatives for treatment. Several international studies have demonstrated very high in vitro susceptibility of these bacteria to fosfomycin. The clinical efficiency of this treatment was tested on acute uncomplicated cystitis due to Escherichia coli subset, with encouraging results. In Hospital Prof. Dr. Fernando Fonseca EPE (HFF) there has been a progressive annual increase in the isolation of these pathogens. The authors’ goal was to test the susceptibility of ESBL-producing Enterobacteriaceae to fosfomycin in HFF and assess its possible therapeutic potential. Material and methods: Prospective study (6 month period), in which the susceptibility to fosfomycin of isolated ESBL-producing Enterobacteriaceae was tested. The VITEK 2® equipment was used to identify the strains. The fosfomycin susceptibility was determined by disk diffusion method (Oxoid®). Statistical analysis was performed using the Microsoft Excel® software. Results: We identified 150 ESBL-producing Enterobacteriaceae, of which 52 % corresponded to Klebsiella pneumoniae and 44% to Escherichia coli. Approximately 88% of Escherichia coli and 68% of Klebsiella pneumoniae were susceptible to fosfomycin. Conclusions: Based on the data obtained at international level and in this study, the authors recommend the use of fosfomycin for the treatment of acute uncomplicated cystitis caused by ESBL-producing Escherichia coli. Future clinical efficacy research is needed in order to substantiate this practice and recommendation.
Introduction: The rising frequency of extended spectrum Beta-lactamase (ESBL) producing Enterobacteriaceae in recent years represents an important public health issue, with scarce effective alternatives for treatment. Several international studies have demonstrated very high in vitro susceptibility of these bacteria to fosfomycin. The clinical efficiency of this treatment was tested on acute uncomplicated cystitis due to Escherichia coli subset, with encouraging results. In Hospital Prof. Dr. Fernando Fonseca EPE (HFF) there has been a progressive annual increase in the isolation of these pathogens. The authors’ goal was to test the susceptibility of ESBL-producing Enterobacteriaceae to fosfomycin in HFF and assess its possible therapeutic potential. Material and methods: Prospective study (6 month period), in which the susceptibility to fosfomycin of isolated ESBL-producing Enterobacteriaceae was tested. The VITEK 2® equipment was used to identify the strains. The fosfomycin susceptibility was determined by disk diffusion method (Oxoid®). Statistical analysis was performed using the Microsoft Excel® software. Results: We identified 150 ESBL-producing Enterobacteriaceae, of which 52 % corresponded to Klebsiella pneumoniae and 44% to Escherichia coli. Approximately 88% of Escherichia coli and 68% of Klebsiella pneumoniae were susceptible to fosfomycin. Conclusions: Based on the data obtained at international level and in this study, the authors recommend the use of fosfomycin for the treatment of acute uncomplicated cystitis caused by ESBL-producing Escherichia coli. Future clinical efficacy research is needed in order to substantiate this practice and recommendation.
Description
Keywords
Infecções bacterianas Fosfomicina
Citation
Med Interna. 2015, 22(3) 131-135
Publisher
Sociedade Portuguesa de Medicina Interna