Neumonía intrahospitalaria : microbiota y resistencia antimicrobiana en el Hospital Docente de la Policia Nacional de Guayaquil No. 2, durante período 2015 - 2017.

Abstract

Objective:To describe the microbiota and antimicrobial resistance of patients with in-hospital pneumonia during the period 2015-2017. Methods: Observational, retrospective and descriptive study of antimicrobial resistance profiles of cultures and antibiograms obtained from141 cases of hospital-acquired pneumonia and ventilation-associated pneumonia. Results:The frequency of isolated etiological agents was: K. pneumoniae (31%), S. aureus (26%), S. maltophilia (13%), P. aeruginosa (12%), E. coli (6%), Enterobacter spp. (6%) and A. baumanii (6%). The general resistance observed was: penicillins resistant to ß-lactamases (92%), aminopenicillins (82%), ureidopenicillins (28%), second generation cephalosporins (85%), third generation cephalosporins (63%), carbapenems (33%),quinolones (46%), aminoglycosides (43%), colistin (0%). The frequencyof antibiotics used as empirical treatment yielded: carbapenems (17%), macrolides (16%) which were used only in combinations, ampicillin/sulbactam (14%), amoxicillin/clavulanic acid (8.5%) piperacillin/tazobactam (8, 5%), third generation cephalosporins (16%), cefepime (7%), quinolones (7.8%), vancomycin (7%) and aminoglycosides (5.7%); antibiotics were used in combination in 30%. 84% of cases (n = 118) were evaluated; they did not meet the criteria in the remaining 16% of cases. 28% of isolated bacteria showed sensitivity to the antibiotics used as empirical treatment, while the remaining 72% was resistant. Discussion:Hospital-acquired pneumonia is important, with potentially lethal results. The most updated clinical guidelines recommend the generation of local antibiograms for the selective use of effective antibiotics. We recommend piperacillin/tazobactam for relatively low resistance, combination with meropenem or imipenem for P. aeruginosa and K. penumoniae, and include linezolid or vancomycin for MRSA.