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Perfil de resistência antimicrobiana na ilha de Santiago (2024): uma perspetiva integrada "uma saúde".
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Introdução: A resistência aos antimicrobianos (RAM) ocorre quando os microrganismos deixam de responder a fármacos que normalmente os eliminariam ou inibiriam, o que dificulta o tratamento e aumenta o risco de mortalidade. Embora envolva várias classes de medicamentos, o impacto é mais crítico nos antibióticos, foco deste estudo. A RAM constitui um dos maiores desafios globais de saúde pública e está diretamente relacionada à abordagem Uma Só Saúde, que integra os domínios humano, animal e ambiental. O uso inadequado de antimicrobianos nesses setores favorece o aparecimento e a disseminação de bactérias resistentes e de elementos genéticos de resistência. Em Cabo Verde, esta problemática assume particular relevância face à escassez de dados sistemáticos e à recente implementação do Plano de Ação Nacional de Luta Contra a Resistência Antimicrobiana (PAN-RAM).
Objetivo: Avaliar o perfil de RAM, com ênfase nos antibióticos, em microrganismos isolados de amostras clínicas na ilha de Santiago, Cabo Verde, em 2024.
Metodologia: Estudo transversal, descritivo e observacional, realizado no Hospital Agostinho Neto, na ilha de Santiago, Cabo Verde. Foram utilizados dados secundários obtidos a partir dos livros de registo de testes de suscetibilidade a antibióticos e do Sistema de Informação Laboratorial. Após a limpeza e a organização, foram realizados controlos de qualidade, com remoção de registos incompletos e exclusão de isolados testados com menos de três antibióticos, para assegurar a robustez dos resultados. No final, foram contabilizados 1.700 isolados e 13.524 antibióticos testados.
Resultado: A amostra incluiu 54,9% de indivíduos do sexo feminino e 45,1% do masculino, distribuídos por todas as faixas etárias. As amostras analisadas foram sobretudo de urina e do trato respiratório, principalmente provenientes do serviço de urgência. Predominaram bactérias de Gram negativo (61,7%). A taxa global de resistência entre os antibióticos testados foi de 37,1%. Além disso, 31,7% dos isolados apresentaram multirresistência. Entre as bactérias de Gram negativo, Escherichia coli e Klebsiella spp. foram os patógenos mais frequentes, apresentando elevadas taxas de resistência à ampicilina, à associação amoxicilina + ácido clavulânico e às cefalosporinas de 3.ª geração. Em contrapartida, mostraram maior suscetibilidade à amicacina e ao imipenem, embora a deteção de estirpes resistentes a carbapenemos constitua um sinal de alerta para potenciais falhas terapêuticas em antibióticos de último recurso. Nas bactérias de Gram positivo verificou-se elevada resistência à penicilina, aos macrólidos e ao sulfametoxazol. Entre os isolados de Staphylococcus aureus foram identificadas estirpes resistentes à meticilina (MRSA), enquanto Streptococcus spp. apresentaram resistências preocupantes, incluindo alguns registos que sugerem suscetibilidade reduzida à vancomicina.
Conclusão: Os resultados evidenciam a dimensão da resistência antimicrobiana e suas implicações clínicas em Cabo Verde. Mais de um terço dos isolados mostrou resistência a pelo menos um antibiótico e quase um terço revelou multirresistência. O padrão de resistência mais elevado foi observado nos antibióticos de primeira linha, restringindo as opções terapêuticas, embora a amicacina e o imipenem ainda apresentem eficácia relativa. Contudo, o aparecimento de estirpes resistentes a carbapenemos exige vigilância reforçada. Estes resultados reforçam a urgência de intensificar as intervenções de saúde pública, manter vigilância epidemiológica contínua e adotar medidas de prevenção e controle de infeções. O estudo fornece ainda uma base de evidência para apoiar a implementação e atualização do PAN-RAM.
Introduction: Antimicrobial resistance (AMR) occurs when microorganisms no longer respond to drugs that would normally eliminate or inhibit them, making treatment difficult and increasing the risk of mortality. Although AMR affects several classes of antimicrobial agents, the impact is most critical with antibiotics, which are the focus of this study. AMR is recognized as one of the greatest global public health challenges and is directly linked to the One Health approach, which integrates the human, animal, and environmental domains. The inappropriate and excessive use of antimicrobials in these sectors favors the emergence and spread of resistant bacteria and genetic elements of resistance. In Cabo Verde, this issue is particularly relevant given the limited availability of systematic data and the recent implementation of the National Action Plan on Antimicrobial Resistance (PAN-RAM). Objective: To evaluate the antimicrobial resistance profile, with an emphasis on antibiotics, in microorganisms isolated from clinical samples on Santiago Island, Cabo Verde, in 2024. Methodology: A cross-sectional, descriptive, and observational study conducted at Agostinho Neto Hospital on Santiago Island, Cabo Verde. Secondary data were obtained from the laboratory’s antibiotic susceptibility testing (AST) logbooks and the Laboratory Information System. After cleaning and organizing the data, 1,700 isolates and 13,524 antibiotics tested results were analyzed. Quality checks included removal of incomplete records and exclusion of isolates tested with fewer than three antibiotics, ensuring robustness of the results. Results: The study population consisted of 54.9% females and 45.1% males, covering all age groups. Gram-negative bacteria predominated (61.7%). Samples were mainly from urine and the respiratory tract, most frequently collected in the emergency department. The overall resistance rate among antibiotics tested was 37.1%, and multidrug resistance (MDR) was observed in 31.7% isolates. Among Gram-negative bacteria, Escherichia coli and Klebsiella spp. were the most frequently isolated pathogens, showing high resistance to ampicillin, amoxicillin–clavulanic acid association, and third-generation cephalosporins. Conversely, amikacin and imipenem retained higher activity against most Gram-negative isolates, although detection of carbapenem-resistant strains raises concern for last-line treatment failures. Gram-positive bacteria showed high resistance to penicillin, macrolides, and sulfamethoxazole. Staphylococcus aureus isolates included methicillin-resistant strains (MRSA), while Streptococcus spp. exhibited worrisome resistance, with some data suggesting reduced susceptibility to vancomycin, a last-resort antibiotic. Conclusion: The findings highlight the magnitude of AMR and its clinical implications in Cape Verde. Over one-third of tested isolates were resistant to at least one antibiotic, and nearly one-third showed MDR. These results reinforce the urgency of intensifying public health interventions, maintaining continuous epidemiological surveillance, and adopting infection prevention and control measures. Furthermore, the study provides an evidence base to support the implementation and updating of the PAN-RAM.
Introduction: Antimicrobial resistance (AMR) occurs when microorganisms no longer respond to drugs that would normally eliminate or inhibit them, making treatment difficult and increasing the risk of mortality. Although AMR affects several classes of antimicrobial agents, the impact is most critical with antibiotics, which are the focus of this study. AMR is recognized as one of the greatest global public health challenges and is directly linked to the One Health approach, which integrates the human, animal, and environmental domains. The inappropriate and excessive use of antimicrobials in these sectors favors the emergence and spread of resistant bacteria and genetic elements of resistance. In Cabo Verde, this issue is particularly relevant given the limited availability of systematic data and the recent implementation of the National Action Plan on Antimicrobial Resistance (PAN-RAM). Objective: To evaluate the antimicrobial resistance profile, with an emphasis on antibiotics, in microorganisms isolated from clinical samples on Santiago Island, Cabo Verde, in 2024. Methodology: A cross-sectional, descriptive, and observational study conducted at Agostinho Neto Hospital on Santiago Island, Cabo Verde. Secondary data were obtained from the laboratory’s antibiotic susceptibility testing (AST) logbooks and the Laboratory Information System. After cleaning and organizing the data, 1,700 isolates and 13,524 antibiotics tested results were analyzed. Quality checks included removal of incomplete records and exclusion of isolates tested with fewer than three antibiotics, ensuring robustness of the results. Results: The study population consisted of 54.9% females and 45.1% males, covering all age groups. Gram-negative bacteria predominated (61.7%). Samples were mainly from urine and the respiratory tract, most frequently collected in the emergency department. The overall resistance rate among antibiotics tested was 37.1%, and multidrug resistance (MDR) was observed in 31.7% isolates. Among Gram-negative bacteria, Escherichia coli and Klebsiella spp. were the most frequently isolated pathogens, showing high resistance to ampicillin, amoxicillin–clavulanic acid association, and third-generation cephalosporins. Conversely, amikacin and imipenem retained higher activity against most Gram-negative isolates, although detection of carbapenem-resistant strains raises concern for last-line treatment failures. Gram-positive bacteria showed high resistance to penicillin, macrolides, and sulfamethoxazole. Staphylococcus aureus isolates included methicillin-resistant strains (MRSA), while Streptococcus spp. exhibited worrisome resistance, with some data suggesting reduced susceptibility to vancomycin, a last-resort antibiotic. Conclusion: The findings highlight the magnitude of AMR and its clinical implications in Cape Verde. Over one-third of tested isolates were resistant to at least one antibiotic, and nearly one-third showed MDR. These results reinforce the urgency of intensifying public health interventions, maintaining continuous epidemiological surveillance, and adopting infection prevention and control measures. Furthermore, the study provides an evidence base to support the implementation and updating of the PAN-RAM.
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Palavras-chave
Resistência antimicrobiana Antibióticos Multirresistência bacteriana Infeções bacterianas Resistência Antibiótico Infeções Hospitalares