Uropatogenos : su resistencia antimicrobiana en 10 países y el comportamiento de la edad y sexo como factores asociados

Abstract

BACKGROUND: Bacterial resistance is a global public health problem. It can cross national and international borders. In addition to the global concern for the increase in bacterial resistance is the significant decrease in the development of new molecules with antimicrobial activity approved by the regulatory agency of food and medicine (fda), which is generating the “perfect storm.” JUSTIFICATION: Antibiotics are among the most prescribed and used drugs in clinical practice. Between 20-50% are not well used, being one of the causes of the development of multidrug-resistant microorganisms. If actions are not taken in a timely manner to reduce the increase in bacterial resistance, it is estimated that by 2050 the number of deaths caused by this cause will reach 10 million annually and a cumulative cost of USD $100 trillion to the global economy would be generated. OBJECTIVE: The objective is to determine if factors such as sex and age are associated with the development of antimicrobial resistance in two most prevalent uropathogens and analyze the SMART epidemiological surveillance program from 2013 to 2017 in 10 countries. METHODOLOGY: To use a mega cross-sectional analytical observational study using 9,090 records from the SMART database from 2013 to 2017, which meet the inclusion and exclusion criteria in three stages: the first, descriptive where demographic and clinical variables were characterized; the second one consisted of bivariate analysis to estimate the association between the dependent variable (antimicrobial resistance) and the independent ones estimating prevalence. 95% CI and RD confidence intervals; and the third one obtaining prediction models that determine the impact of the factors and strength of association. RESULTS: 9,090 records were included: 6,332 (69.7%) of the female sex, 68.2%> 51 years; 24.1% adults, 2.4% adolescents, and 5.3% children. 48.8% of the records corresponded to patients with 48 or more hours of hospitalization and 7% were hospitalized in the intensive care unit; 94.5% of uropathogens were isolated in urine. Factors associated with the resistance of E. coli to Ertapenem were: male gender (RD 1.69; 95% CI 1.28-2.23), hospitalization time greater than 48 hours (RD 1.50; CI 95 %: 1.14-1.98), and being in ICU (RD 1.82; 95% CI: 1.17-2.85). Regarding E. coli when the treatment is with Ceftriaxone, the following factors were significantly associated: male gender (RD 1.69; 95% CI 1.52-1.89), more than 48 hours hospitalized (RD 1.68; 95% CI: 1.52-1.86). In Klebsiella pneumoniae, the factors that explain the development of antimicrobial resistance were: male gender (RD 1.54; 95% CI: 1.24-1.91), more than 48 hours of hospitalization (RD 1.72; 95% CI : 1.39-2.14), ICU care (RD 2.02; 95% CI: 1.48-2.75) adolescent age (RD 2.79; 95% CI: 1.09-7.15 ), adult (RD 2.91; 95% CI: 1.43-5.93), and senior (RD 2.62; 95% CI: 1.32-5.20). Regarding Ceftriaxone resistance, it is explained by the following factors: male gender (RD 1.61; 95% CI 1.34-1.92), more than 48 hours hospitalized (OR 1.84; 95% CI: 1, 54-2,19), and ICU (OR 1.61; 95% CI: 1.21-2.15). CONCLUSIONS: According to the finding of the study of the male gender, hospital stay longer than 48 hours explain the decrease in the susceptibility of E. coli and Klebsiella pneumoniae to Ertapenem and Ceftriaxone. In addition, antimicrobial resistance is directly proportional to the increase in age. In our study, being under 8 years old was a protective factor. New research is necessary to evaluate other clinical factors that were not included in the present study, as well as the associated resistance mechanisms.