Banca de QUALIFICAÇÃO: SABRINA PAULA PEREIRA

Uma banca de QUALIFICAÇÃO de MESTRADO foi cadastrada pelo programa.
STUDENT : SABRINA PAULA PEREIRA
DATE: 10/06/2022
TIME: 13:30
LOCAL: videoconferência
TITLE:

Infection caused by carbapenem-resistant gram-negative bacteria in patients with chronic kidney disease: a systematic review

KEY WORDS:

Chronic Kidney Failure, Bacteria, Carbapenems

PAGES: 57
BIG AREA: Ciências da Saúde
AREA: Farmácia
SUMMARY:

Introduction: Chronic kidney disease is characterized by the progressive and irreversible loss of kidney function. About 144,7779 patients are on dialysis in Brazil. Infections caused by carbapenem-resistant Gram-negative bacteria are associated with higher mortality, longer hospital stay and greater economic burden. The increased resistance of Gram-negative bacteria to carbapenem antimicrobials is particularly relevant for patients with chronic kidney disease (CKD) who are vulnerable to these infections. General objective: To evaluate the prevalence of infections caused by gram-negative bacteria resistant to carbapenems in patients with chronic kidney disease and in kidney transplant patients. In addition, discuss the epidemiology of these infections, prevention and treatment strategies, as well as future directions in combating antimicrobial resistance. Method: This is a systematic review carried out according to Cochrane guidelines with extraction of data of interest and analysis of results carried out in accordance with the PRISMA statement (2022), seeking to assess the presence or development of infection caused by bacteria Carbapenem-resistant gram-negatives in patients with chronic kidney disease or patients on dialysis or kidney transplant patients. Results: After analysis, a total of 13 articles were included in this review: Pubmed (2), Web Of Science (5), ,Scopus (1) (7.7%) and Embase (5). published in the United States (30.7%), followed by Brazil (15%), South Korea, (7.7%) Israel, (7.7%) China, (7.7%) Spain, (7, 7%) Italy, (7.7%) Colombia (7.7%) and Greece (7.7%). Regarding the study design, 9 were retrospective cohorts, (69%), 3 were case control (23%) and 1 cross-sectional study (7.7%). The age range of the individuals ranged from 18 to 75 years (mean 46.5) and the follow-up time ranged from 6 months to 10 years. The bacterial identification methodology that prevailed among the analyzed articles was the automated VITEk2R (8 studies, 61.5%) and the most prevalent Gram-negative bacteria species were: Klebsiella pneumoniae (11/84.6%), Escherichia coli (6/46%), Pseudomonas aeruginosa 2 (15.4%), Citrobacter sp 2 (15.4%). ,Enterobacter sp 2 (15.4%), Morganella Morganii 1 (7.7%), Proteus mirabiliis 1 (7.7%) and Providência stuarti 1 (7.7%). The predominant sites of infection were the urinary tract 10 (77%) bronchoalveolar lavage, blood and feces with 1 (7.7%) site each and surveillance cultures were also reported (38.4%). For the detection of resistance to carbapenems, the molecular method (PCR 38.4%), modified Hodge method (23%), Kirby Bauer (15.4%) and CarbaNP (7.7%) were used in the studies, considering as reference the protocols of the Clinical and Laboratory Standards Institute (CLSI) (69%) and the European Committee on Antimicrobial Susceptibility Testing (Eucast) (7.7%). The bacterial resistance mechanisms found in bacterial isolates were production of inactivating enzymes: KPC (53.8%), NDM (7.7%) and VIM (7.7%), ESBL (15.4%) were also detected. As a clinical outcome, it was possible to observe that diabetic patients or those with a history of colonization by multidrug-resistant Gram-negative bacteria had a worse prognosis. The mortality rate ranged from 41.9% to 79% at 30 days, while in transplant patients infected with KPC-producing bacteria, the median survival was one month.

BANKING MEMBERS:
Presidente - 2028750 - CAROLINE PEREIRA DOMINGUETI
Externa ao Programa - 1581671 - MAGNA CRISTINA DE PAIVA
Externo ao Programa - 1676450 - GUSTAVO MACHADO ROCHA
Externa ao Programa - 1347706 - ALBA OTONI
Externa à Instituição - NAYARA RAGI BALDONI COUTO