Clinical, microbiological and pharmacoepidemiological identification of enterobacteria with increased resistance in a public hospital in Ceará




Objectives: to identify the clinical, microbiological and pharmacoepidemiological profile of patients with enterobacteria with increased resistance in a public teaching hospital in Ceará. Methods: Observational and retrospective study, carried out between January 2020 and December 2021. The microbiological and demographic profile was obtained through microbiology laboratory reports and information obtained from medical records. Variable frequencies were compared using the Chi-square test, considering p < 0.05. Study approved with opinion of the ethics committee nº 3.697.674. Results: A total of 164 patients had positive culture results (n=248) for enterobacteria with an enhanced resistance profile. The highest proportion was male (60.98%, n=100, with a mean age of 58.9 years and mean hospitalization time was 51.3 days. Klebsiella pneumoniae was the most isolated bacteria (88.31%, n=218), with tracheal aspirate (39.11%, n=97) being the most prevalent type of culture, followed by blood culture (27.42%, n=68) and urine culture (16.94%, n=42). The blaKPC gene was the most prevalent, being identified in 49.19% (n=122) of the isolates, followed by blaNDM with 11.29% (n=28). When checking the sensitivity profile, it is noted that 68.55% of the isolates are sensitive to colistin and only about 30% to aminoglycosides. In 18.57% they already showed resistance to ceftazidime-avibactam. As for the clinical outcome, 57.32% (n=94) of the patients died. Previous use of antimicrobials (p=0.024), surgical procedure (p=0.049), admission to an intensive care unit (p<0.001), presence of neutropenia (p=0.005) and use of invasive devices (p<0.001) were statistically significant. Conclusion: These findings show the importance of knowing the clinical profile of patients infected with enterobacteria with increased resistance, since targeted strategies should be designed in favor of better management of antimicrobials against microorganisms such as K. pneumoniae, a strong candidate for the production of carbapenemase, an important cause of bacteremia and which can sometimes be resistant to last-choice antimicrobials, facts associated with high mortality.


Download data is not yet available.


Alvan G, Edlund C, Heddini, A. The global need for effective antibiotics – A summary of plenary presentations. Drug Resistance Updates. 2011;14(2):70-77. DOI: 10.1016/j.drup.2011.01.007.

Butler M, Cooper M. Antibiotics in the clinical pipeline in 2011. Journal of Antibiotics. 2011;64(6):413-425. DOI: 10.1038/ja.2011.44

Marquiotei CMJ, Lantes LC, Castro GFC. Uso irracional de antibióticos na infância: contribuição do profissional farmacêutico para a promoção da saúde. Revista Transformar. 2015; 7(7):179-193.

Lima CC, Benjamim SCC, Santos RFS. Mecanismo de resistência bacteriana frente aos fármacos: uma revisão. CuidArte, Enferm. 2017;11(1):105-113.

Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016;4(2). DOI: 10.1128/microbiolspec.VMBF-0016-2015.

Bush K, Jacoby GA. Updated functional classification of beta-lactamases. Antimicrob Agents Chemother. 2010;54(3):969-76. DOI: 10.1128/AAC.01009-09

Wink PL, Martins AS, Volpato F, Zavascki AP, Barth AL. Increased frequency of blaNDM in a tertiary care hospital in southern Brazil. Brazilian Journal of Microbiology. Brazilian Society for Microbiology. 2021;52(1):299–301. DOI: 0.1007/s42770-020-00412-z

Rozales FP, Lovison OA, Magagnin CM, Martins AS, Crispim MN, Zavascki AP, et al. Characteristics of Enterobacteriaceae Isolates Coharboring Distinct Carbapenemase Genes. Infection Control and Hospital Epidemiology. 2017;38(9):1123–6. DOI: 10.1017/ice.2017.146.

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases [Internet]. 2016;62(10):e51–77. DOI: 10.1093/cid/ciw118.

Shirley M. Ceftazidime-Avibactam: A Review in the Treatment of Serious Gram-Negative Bacterial Infections. Drugs. 2018;78(6):675-692.

Van DD, Bonomo RA. Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/β-Lactamase Inhibitor Combinations. Clin Infect Dis. 2016;63(2):234-41.

Alvim A, Couto BRGMC, Gazzinelli A. Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study. Enfermería Global. 2020;19(2):257–86. DOI: 10.6018/eglobal.380951

Souza SCS, Silva DF, Belei RA, Carrilho CMD. Factors associated with the mortality of patients with Enterobacteriaceae carbapenem-resistant. Medicina. 2016;49(2). DOI: 10.11606/issn.2176-7262.v49i2p109-115

Alves AP, Behar PRP. Infecções hospitalares por enterobactérias produtoras de Kpc em um hospital terciário do sul do Brasil. Rev AMRIGS. 2013;213–8.

Borges FK, Moraes TA, Drebes CVE, Silva ALT da, Cassol R, Falci DR. Perfil dos pacientes colonizados por enterobactérias produtoras de KPC em hospital terciário de Porto Alegre, Brasil. Clinical and Biomedical Research. 2015;35(1).

Bassetti M, Poulakou G, Ruppe E, Bouza E, Van Hal SJ, Brink A. Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach. Intensive Care Medicine. 2017;43(10):1464–75.

Lavagnoli LS, Bassetti BR, Kaiser TDL, Kutz KM, Cerutti JC. Fatores associados à aquisição de Enterobactérias resistentes aos carbapenêmicos. Revista Latino-Americana de Enfermagem. 2017;25:e2935. DOI: 10.1590/1518-8345.1751.2935

Kernéis S, Lucet JC, Santoro A, Meschiari M. Individual and collective impact of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in patients admitted to the ICU. Journal of Antimicrobial Chemotherapy. 2021;76(Supplement_1):i19–26.

Alencar DL de, Conceição ADS, Silva RFA da. Occurrence of nosocomial infection in intensive care unit of a public hospital. Revista Prevenção de Infecção e Saúde. 2020;6. DOI: 10.26694/repis.v6i0.8857

Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American Journal of Infection Control. 2007;35(10):S65–164. DOI: 10.1016/j.ajic.2007.10.007

Hayden MK, Lin MY, Lolans K, Weiner S, Blom D, Moore NM, et al. Prevention of Colonization and Infection by Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae in Long-term Acute-Care Hospitals. Clinical Infectious Diseases. 2014;60(8):1153–61. DOI: 10.1093/cid/ciu1173

Moradigaravand D, Martin V, Peacock SJ, Parkhill J. Evolution and Epidemiology of Multidrug-Resistant Klebsiella pneumoniae in the United Kingdom and Ireland. 2017;8(1). DOI: 10.1128/mBio.01976-16

Pinto FM, Simas DM, Baldin CP, Limberger II, Silva RCF da, Antochevis LC, et al. Prevalência de carbapenemases em enterobactérias resistentes a carbapenêmicos em quatro hospitais terciários de Porto Alegre. Clinical and Biomedical Research. 2014;34(1)

Tekeli A, Dolapci İ, Evren E, Oguzman E, Karahan ZC. Characterization of Klebsiella pneumoniae Coproducing KPC and NDM-1 Carbapenemases from Turkey. Microbial Drug Resistance. 2020;26(2):118–25. DOI: 10.1089/mdr.2019.0086.

Mesquita RF, Lima CAL de O, Lima LVA, Aquino BP, Medeiros MS. Uso racional de antimicrobianos e impacto no perfil de resistência microbiológica em tempos de pandemia pela Covid-19. Research, Society and Development. 2022;11(1):e58211125382. DOI: 10.33448/rsd-v11i1.25382

Antochevis LC, Magagnin CM, Nunes AG, Goulart TM, Martins AS, Cayô R, et al. KPC-producing Klebsiella pneumoniae bloodstream isolates from Brazilian hospitals: What (still) remains active? Journal of Global Antimicrobial Resistance. 2018;15:173–7. DOI: 10.1016/j.jgar.2018.07.011.

Huemer M, Mairpady SS, Brugger SD, Zinkernagel AS. Antibiotic resistance and persistence-Implications for human health and treatment perspectives. EMBO Rep. 2020;21(12):e51034

Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, Present and Future. Current Opinion in Microbiology. 2019 Oct;51(1):72–80. DOI: 10.1016/j.mib.2019.10.008.



How to Cite

SILVA JC, REIS HP, SAMPAIO TL, ALCÂNTARA-NETO JM, AMARAL GP, ARAÚJO RO, GIRÃO ES, RODRIGUES JL. Clinical, microbiological and pharmacoepidemiological identification of enterobacteria with increased resistance in a public hospital in Ceará. Rev Bras Farm Hosp Serv Saude [Internet]. 2023Jun.29 [cited 2023Sep.29];14(2):976. Available from:




Most read articles by the same author(s)