A-255 Microbiological Profile and Frequency Distribution of Uropathogens in Brazilian Public Hospitals. Data From a Clinical Laboratory (2018-2023)
Authors: Ramadan-Boscolo D R , Nurmberger J M , Inoue F M , Lobo A P , de Andrade S S , Tufik S 
Published: October 2024

Abstract

Background
Urinary tract infections (UTIs) are among the most common infectious diseases in humans and represent a critical health problem, especially due to a significant rise in global antibiotic use in recent years. The purpose of this study was to describe the main uropathogens and determine the antimicrobial resistance profiles among inpatients at public hospitals in the largest city in Brazil, comparing three different epidemiological periods: pre-Covid-19 (2018-2019), Covid-19 (2020-2021) and post-Covid-19 (2022-2023).

Methods
A 6-year retrospective review of laboratory data from 12 public hospitals of São Paulo city from January 2018 to December 2023. The urine samples were cultivated onto ChromID® CPS agar plates and then incubated at 35°C for 18-24 h. The bacteria identification was performed by MALDI-TOF mass spectrometry (Vitek-MS), and the minimal inhibitory concentrations of antibiotics were determined using the Vitek®2 system. Only positive results with one bacterial species and a colony count ≥ 105 CFU/mL was considered for descriptive analysis.

Results
In the 6-year period, a total of 58,738 microorganisms from hospitalized patients were included. The frequency of isolates detected during the period were: 33.9% (19,338/58,738) in pre-Covid-19, 30.1% (17,688/58,738) in Covid-19 and 36.9% (21,712/58,738) in post-Covid-19 period. The top ten microorganisms’ prevalence detected in pre-Covid-19, Covid-19 and post-Covid-19 periods were as follow: 23,951 Escherichia coli (47.5%; 37.1%; 37.7%), 9,247 Klebsiella pneumoniae (12.5%; 14.3%; 19.8%), 7,640 Candida spp. (8.8%; 19.2%; 11.7%), 5,476 Enterococcus spp. (8%; 10%; 9.9%), 3,101 Proteus mirabilis (5.56%; 4.9%; 5.4%), 2,166 Pseudomonas aeruginosa (3.3%; 3.5%; 4.1%), 1,252 Coagulase-Negative Staphylococcus (CoNS) (2.5%; 1.6%; 2.2%), 1,166 Enterobacter spp. (2.3%; 2.1%; 1.6%), 1,088 Streptococcus spp. (3.6%; 1.2%; 0.8%) and 758 Acinetobacter spp. (0.8%; 1.5%; 1.5%). Extended spectrum beta-lactamase rates for E. coli were 16.8% and 20.2% and for K. pneumoniae were 65.7% and 65.2% in Covid-19 and Post-Covid-19 periods, respectively. The resistance to carbapenems was observed mainly in Acinetobacter spp. (85.7%, 93.8% and 80.7%), K. pneumoniae (38.3%, 42.6% and 47.3%), Pseudomonas aeruginosa (22.3%, 23.1% and 25%), and Proteus spp. (0.2%, 1.9% and 5%). Between the Gram-positive cocci, the resistance to vancomycin was observed mainly in E. faecium (43.5%, 37.5%, 30.2%) and the resistance to methicillin was detected in S. aureus (30.1%, 35.8%, 34.1%) and CoNS (31.9%, 47.8%, 53.5%).

Conclusions
In this study, we observed an increase in the incidence of Candida spp. coinciding with the start of the pandemic period. Overall, the frequency of uropathogens isolated from hospital centers increased and exhibited high resistance to various classes of antimicrobial agents. ESBL-producing K. pneumoniae and Carbapenem-resistant Enterobacteriacea, and nonfermenters such as Acinetobacter spp. and P. aeruginosa constitute serious problems in Brazilian hospitals.