Padrão de resistência antimicrobiana entre os microrganismos associados à infecção do trato urinário em pacientes pediátricos: uma revisão de escopo

Abstract

Introduction: Urinary tract infection (UTI) is characterized by the multiplication of pathogens in any segment of the urinary tract, confirmed by the identification of the microorganism in the uroculture test. It is one of the main causes of hospitalization in paediatrics and is highly relevant due to the high risk of developing sequelae such as renal scarring, especially if there is a delay in diagnosis and starting treatment. The susceptibility profile of pathogens to the antimicrobials used varies according to geographical region, age group and gender, but in general there is an increase in resistance rates to the antimicrobials used, making it a worldwide problem. Objetive: To describe the pattern of antimicrobial resistance among microorganisms associated with urinary tract infections in pediatric patients. Materials and Methods: A scoping review was carried out, following a research protocol constructed according to the guidelines of the JBI Scoping Review Methodology Group and its report structured according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Checklist - extension for Scoping Review (PRISMA-ScR). The following databases were consulted: BVS, SciELO, MEDLINE/PubMed and Google Scholar and studies with an observational design involving patients (primary) or patient data (secondary) between zero and eighteen years of age, whose objective was to evaluate the rate of antimicrobial resistance of microorganisms associated with UTI through urocultures with antibiogram, were eligible. Eligible studies were those published between 2018 and 2023 in Portuguese, English or Spanish and which tested at least 10 antimicrobials in the antibiogram. The search strategy to screen the studies was designed using DeCS and MeSH, and the Rayyan QRCI tool was used to remove duplicates and manage the studies to be evaluated by the researchers. Results: of the 709 studies identified, 15 were selected that met the criteria required in this review. According to the data extracted from these papers, the most common microorganisms were Escherichia coli, followed by Klebsiella pneumoniae and Enterococcus faecalis with frequency rates of 65.4%, 10.9% and 4.89% respectively. Of the 10 antimicrobials analyzed, ampicillin had the highest resistance rate of 63.1%, followed by sulfamethoxazole trimethropim with 48.9% and amoxicillin clavulanate with 45.74%. Meropenem and amikacin were the antimicrobials with the lowest resistance rates of 6.43% and 6.78% respectively. Conclusion: There are significant rates of resistance to the main antimicrobials available, as well as great variability in these rates depending on the country and region studied, thus explaining the importance of carrying out local studies that identify the most prevalent microorganisms and the antimicrobial resistance profile.