Infecção do trato urinário em crianças de um hospital público do Pará-Brasil: perfil clínico-epidemiológico e genotipagem dos uropatógenos

Abstract

Urinary Tract Infection (UTI) is one of the most common diseases of childhood and in 80 to 90% of the cases are caused by bacteria of Enterobacteriaceae family, especially Escherichia coli and Klebsiella pneumoniae, which have emerged in the worldwide as ESBL producer, one of the main mechanisms of bacterial resistance to extended-spectrum cephalosporins and monobactans. UTI prevalence in children, as well as another variable as gender, age, fever, most common bacteria, presence of vesicoureteral reflux (VUR) and of renal scars; were evaluated between January 2006 and March 2009, in a public hospital in Belém, northern Brazil. And in the period of April to August of 2009 isolates of E.coli and K.pneumoniae were obtained from the urine samples of children and evaluated phenotypically using the method automated of characterization of ESBL, Vitek2 system. PCR was used to determine whether the genes blaTEM, blaSHV and blaCTX-M1 were present ineach organism. There were 199 confirmed cases of UTI during the study period, 54.2% were female, 46.2% were under 02 years old, fever occurred in 37.3% of cases, VUR was identified in 38.6% of children with UTI and renal scarring in 38%, the most common bacteria was E.coli (60%). We isolated 43 samples (E.coli and K.pneumoniae, 74.4% and 25.6%, respectively), 95% were resistant to ampicillin and trimethoprim-sulfamethoxazole, 23.2% had ESBL phenotype. The blaCTX-M1 was the most prevalent gene, found in 19 strains, followed blaTEM (18 strains) and blaSHV (8 strains) genes. This study showed that bacteria with resistance profile of ESBL circulate in the hospital environment in Belém and the genes blaCTX-M1, blaTEM and blaSHV are present in E. coli and K. pneumoniae causing UTI in children in northern Brazil.