Increased resistance rates of extended-spectrum β-lactamase-producing Enterobacterales isolated from blood cultures in Brazil

Raí Emanuel da Silva; Nathanael dos Santos Alves; Cynthia Karolina Rodrigues do Nascimento; Raylane Meneses Marques dos Santos; Wellerson Lucas de Pinho Barreto; Jadiel Silva Reis Filho; Victor Brito Dantas Martins; Erika Cecília Vallim Severino; Marcelo Costa Araújo; Miguel Araújo Rios Neto; Aline Dias Paiva; Kennio Ferreira-Paim; Fernanda Machado Fonseca

doi:10.14393/BJ-v40n0a2024-69495

Authors

Raí Emanuel da Silva Universidade Federal do Piauí https://orcid.org/0000-0002-4266-0475
Nathanael dos Santos Alves Universidade Federal do Delta do Parnaíba
Cynthia Karolina Rodrigues do Nascimento Universidade Federal do Delta do Parnaíba
Raylane Meneses Marques dos Santos Universidade Federal do Delta do Parnaíba
Wellerson Lucas de Pinho Barreto Universidade Federal do Delta do Parnaíba
Jadiel Silva Reis Filho Universidade Federal do Delta do Parnaíba https://orcid.org/0000-0002-4484-4876
Victor Brito Dantas Martins Universidade Federal do Delta do Parnaíba https://orcid.org/0000-0002-6932-915X
Erika Cecília Vallim Severino Universidade Federal do Triângulo Mineiro https://orcid.org/0000-0001-5347-3862
Marcelo Costa Araújo Universidade Federal do Triângulo Mineiro
Miguel Araújo Rios Neto Universidade Federal do Delta do Parnaíba
Aline Dias Paiva Universidade Federal do Triângulo Mineiro
Kennio Ferreira-Paim Universidade Federal do Triângulo Mineiro https://orcid.org/0000-0002-6035-8392
Fernanda Machado Fonseca Universidade Federal do Triângulo Mineiro https://orcid.org/0000-0002-5326-0776

DOI:

https://doi.org/10.14393/BJ-v40n0a2024-69495

Keywords:

Beta-lactamases, Blood culture, Drug resistance

Abstract

This study aimed to identify and evaluate the antimicrobial susceptibility profile of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales isolated from blood cultures of patients with suspected sepsis. This retrospective cross-sectional epidemiological study was performed for four years (2015 to 2018) by accessing the medical records of patients diagnosed with bloodstream infections in two tertiary public hospitals in Brazil. Culture results and susceptibility tests of bacterial strains isolated from blood samples were analyzed. During four years, 2,263 blood culture exams were performed, and Enterobacterales were isolated in 694 (30.7%) samples. The disk approximation test detected ESBL production in 171 (24.6%) of the 694 isolated Enterobacterales (p<0.05), with 125 (73.1%) corresponding to Klebsiella spp., 28 (16.2%) to Escherichia coli, eight (4.6%) to Enterobacter spp., five (2.9%) to Serratia spp., three (1.7%) to Proteus spp., and two (1.2%) to Citrobacter spp. All tested antibiotics demonstrated low susceptibility (2.9% to 26.9%). The classes of monobactams, cephalosporins, and penicillin showed high resistance indices. The evaluated Enterobacterales isolates exhibited expressive antimicrobial resistance to drugs commonly used as empirical treatment in bloodstream infections. The findings reinforce the relevance of assessing the bacterial antimicrobial susceptibility profile, as it drives antibiotic therapy, potentially detecting multiresistance cases.

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