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Previous issue date: 2015-06-12 === O crescente aumento da resist?ncia aos antimicrobianos em Pseudomonas aeruginosa ? um exemplo not?vel de como as bact?rias podem manter e expressar novas informa??es gen?ticas que conferem resist?ncia a uma ou v?rias drogas. No presente estudo avaliou-se a susceptibilidade aos antimicrobianos em isolados de P. aeruginosa em tr?s grandes centros de refer?ncia do Estado do Rio Grande do Norte: Laborat?rio Dr. Almino Fernandes (LACEN-RN), Laborat?rio de An?lises Cl?nicas do HUOL e Laborat?rio de An?lise Cl?nicas do Hospital Giselda Trigueiro (HGT). Os isolados foram obtidos entre janeiro de 2013 e junho de 2014, onde 113 cepas foram isoladas de diversas amostras cl?nicas por demanda espont?nea. A esp?cie de P. aeruginosa foi identificada inicialmente nos laborat?rios de origem e confirmada, atrav?s de testes fenot?picos, no Laborat?rio de Micobact?rias (LABMIC) da Universidade Federal do Rio Grande do Norte - UFRN. A determina??o da susceptibilidade deu-se atrav?s do Teste de Disco Difus?o. Ap?s determina??o do perfil de resist?ncia, as amostras foram submetidas ? avalia??o fenot?pica confirmat?ria. Do total de 113 isolados 67,2% (n = 76) apresentaram perfil de resist?ncia a, pelo menos, uma classe de antimicrobianos. Todas as cepas de P. aeruginosa foram suscept?veis a Polimixina B. As maiores taxas de resist?ncia foram verificadas frente ? Ofloxacina (57,5%), ciprofloxacina (55,7%), Norfloxacina (55,7%), ticarcilina-?cido clavul?nico (43,3%), ceftazidima (41,5%), Meropenem (39,8%), Aztreonam e Cefepime (38,9%). A frequ?ncia de resist?ncia foi menor frente ? imipenem (36,2%), tobramicina (36,2%), piperacilina-tazobactam (36,2%) e amicacina (28,3%). Das 113 cepas estudadas, 46 (40,7%) apresentaram resultados fenot?picos positivos para produ??o de ?-Lactamases do tipo AmpC. 50 (44%) apresentaram resist?ncia a, pelo menos, um dos carbapen?micos avaliados, e estas foram submetidas ao teste de detec??o fenot?pica para produ??o de Metallo Beta Lactamase - M?L. Das 50 amostras com resist?ncia a carbapen?micos, 21 (42%) apresentaram teste fenot?pico positivo para produ??o de metallo-?-lactamase a partir do teste de bloqueio enzim?tico, sendo presuntivamente consideradas produtoras de M?L. A partir dos dados obtidos, conclu?mos que a identifica??o precoce de pat?genos e a an?lise da resist?ncia de microrganismos aos antimicrobianos constituem importante ferramenta para auxiliar os cl?nicos no tratamento de infec??es. Dessa forma, conhecer o perfil de susceptibilidade aos antibi?ticos de P. aeruginosa pode nortear a escolha de terapia emp?rica. === The enhanced antimicrobial resistance in Pseudomonas aeruginosa is a remarkable example of how the bacteria can maintain and express the new genetic information conferring resistance to one or more drugs. In the present study we evaluated the profile of antimicrobial susceptibility in isolates of P. aeruginosa from three major Rio Grande do Norte state reference centers: Laboratory Dr. Almino Fernandes (LACEN-RN), Laboratory of Clinical Analysis of HUOL and Analysis Laboratory of Clinical Hospital Giselda Trigueiro (HGT). The isolates were obtained between January 2013 and June 2014, in which 113 strains were isolated from various clinical specimens by spontaneous demand. The species of P. aeruginosa was first recognized in home laboratories and confirmed by phenotypic tests, the Mycobacteria Laboratory (LABMIC) of the Federal University of Rio Grande do Norte - UFRN. The determination of antimicrobial susceptibility was given through the disk diffusion test. After determining the resistance profile, the samples were subjected to confirmatory phenotypic evaluation to beta lactamase producing AmpC type detection and Metallo Beta Lactamase. Of the 113 isolates 67.2% (n = 76) showed resistance profile of the at least one class of antimicrobials. All strains of P. aeruginosa were susceptible to Polymyxin B. The highest resistance rates were checked against the ofloxacin 57.5% (n = 65), Ciprofloxacin 55.7% (n = 63), Norfloxacin 55.7% (n = 63), Ticarcillin-clavulanic acid 43.3% (n = 49) Ceftazidime 41.5% (n = 47), Meropenem 39.8% (n = 45), and Aztreonam Cefepime 38.9% (n = 44), Imipenem 36.2% (n = 41 ) Tobramycin 36.2% (n = 41), piperacillin-tazobactam 28.3% (n = 32) and amikacin 28.3% (n = 32). Of the 113 strains studied, 46 (40.7%) showed positive phenotypic results for the production of ?-lactamases AmpC type of approach through the disk method. Fifty (44%) isolates showed resistance to at least one of the evaluated carbapenems, and these were subjected to phenotypic screening test for production Metallo Beta Lactamase - MBL, by blocking enzymatic test with discs combined with EDTA. Of the 50 samples with resistance to carbapenems, 21 (42%) showed positive phenotypic test for the production of metallo-?-lactamase producing considered presumptively with MBL. The data demonstrate high production of ?-lactamases type ampC Metallo-and ?-lactamase. It was also observed high antimicrobial resistance rates, especially carbapenems. Therefore it is concluded that early identification of pathogens and analysis of microorganisms to antimicrobial resistance constitute an important tool to assist clinicians in the treatment of infections.
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