Epidemiological screening of pathogenicity factors associated with multidrug-resistant bacteria isolated in uroculture of hospitalized neonates in the lakes region from Rio

The discovery of antimicrobials revolutionized the treatment of infectious diseases caused by bacteria, as they are drugs that contribute to reducing morbidity and mortality rates associated with infectious diseases (JANEBRO, et al., 2008). However, the irrational use of antimicrobial drugs represents one of the main concerns worldwide, since the misuse of these drugs accelerates the natural process of bacteria resistance to antibiotics (ZIMERMAN, 2010). In view of all these problems, the objective of this study was to evaluate the profile of resistance of bacteria identified in the urine culture of neonates who are hospitalized, based on the records of the Laboratory of Clinical Analysis of a hospital in the lakes region from Rio de Janeiro. To do so, we used the following methodologies: (i) literature review for contextualization of the problem and basis for discussion; (ii) and monitoring of a descriptive observational study that had as instrument the reports of records containing results of urine culture and antibiogram of neonatal patients, referring to the period from January 2020 to September 2021. The results showed a higher incidence of Escherichia coli (44% - 2020; 56% - 2021) among the microorganisms isolated in the analyzed urine cultures, followed by Klebsiella pneumoniae (14% - 2020; 28% - 2021). Antimicrobials from the β-lactam group caused high bacterial resistance, among the strains of different microorganisms analyzed, increasingly indicating the need for the replacement of these drugs in the clinic, in order to choose a better therapy for the patient. As in any infectious pathology, to establish appropriate prevention and treatment of community-acquired urinary tract infections, effective and continuous research is needed, with the goal of defining in detail the etiology and profile of bacterial resistance in regional, national, and international standards. It is hoped that these new data profiling the level of resistance in which microorganisms isolated from neonatal patients admitted under hospital regimen are found will be of great value to the academic community and to health professionals, providing users with increasingly accurate and quality treatment.


Introduction
The discovery of antimicrobials revolutionized the treatment of infectious diseases caused by bacteria, because they are drugs that contribute to the reduction of morbidity and mortality rates morbidity and mortality rates associated with infectious diseases (JANEBRO, et al., 2008) The first historical reports related to these drugs were through Pasteur and Jouber in 1877.
In 1936, sulfonamides were introduced in the therapeutic treatment patients, ushering in the modern era of antimicrobial chemotherapy. The landmark milestone in relation to these drugs was reported in 1941, with the introduction of penicillin, because a revolution occurred in the therapeutic principles used in the treatment of infectious infectious diseases. Consequently, there was progress in the isolation and discovery of new and more potent more potent antimicrobial agents (JANEBRO, et al., 2008).
In terms of public health, the irrational use of antimicrobial drugs represents one of the major global concerns, since the misuse of these drugs accelerates the natural the natural process of bacterial resistance to antibiotics. Microbial resistance was percussion of the strains of microorganisms that are able to proliferate in the presence of concentrations of antibiotics higher than human therapeutic doses. Thus, bacterial resistance represents a risk to the quality of human life achieved over the years, besides contributing to increased costs in the health system and the hospitals themselves. Therefore, the irrational use of these drugs has increasingly favored the increase the increase of this problem. In Brazil, few resources are used for monitoring actions on the rational use of antimicrobials (ZIMERMAN, 2010). is frequent, and is considered one of the most common infections is frequent, being considered one of the most prevalent bacterial infections among infants. infants. In neonates it is a particularly serious infection, due to the risk of formation of pyelonephric scar formation (LOPES, et al., 2005).
The urinary tract does not contain infectious microorganisms in healthy people, and When it has the amount is minimal to cause an infection, but this is subject to opportunistic infections that can cause serious problems. Although infections by other pathogens occur, most infections that occur in the urinary tract are bacterial (COSTA, et al., 2010).

Materials and Methods
A literature review was performed on aspects of bacterial resistance in uroculture of neonates. The contents will provide a broad spectrum on the topic approached seeking an understanding in the professional field, as well as the specific aspects specific aspects directed to bacterial resistance in neonatal urine culture.
The descriptors in Health Sciences (Decs) were used, with the following key words: bacterial resistance, UTIs, types of bacteria causing UTIs and irrational use of antimicrobials.

Results and discussion
The results of the observational study established a total of 231 (100%) (N=231) records of urocultures of newborn patients from the pediatric ICU ward of a hospital in the Lake District in the year 2020, from January to September. Interestingly, 22% (n=50) of these exams presented as positive urine cultures, being directly directed to perform the antimicrobial sensitivity test (ASCT). Exams that showed no evidence of infection represented 78% of the exams (n=181).

Source: Authors, 2022
The information on UTIs related to the year 2020 (22%), when compared to the infections of the year 2021 (18%), is similar to different studies available in the literature and that were selected in our review such as Grillo and collaborators (2013) Figure 2). Other authors also present percentages that vary from 28.7% (RIEGER; HORTA, 2003) to 75% (KAHLMETER, 2000), this variation depends on the public studied.
When analyzing the records of the urine culture tests that were positive (n=50) in the year 2020, the presence of twelve different species of different uropathogens were observed.
Our study could verify the prevalence of multiresistant bacteria in a neonatal ICU of a hospital in the lakes region, where it was possible to observe mechanisms of resistance of these microorganisms, such as the production of extended-spectrum β-lactamase, which includes E.
coli and Klebsiella pneumoniae, which ends up resulting in greater difficulty in treating urinary tract infection, requiring the use of broad-spectrum antibiotics with constancy, which makes it difficult to treat newborns with UTIs due to the restriction on the use of antibiotics, which ends up increasing the incidence of bacteria and helping the progression of the infection.
It is of utmost importance to conduct research that collects knowledge about the regional prevalence of uropathogens and their antimicrobial resistance profile. These studies provide the medical community with options to choose among several therapeutic alternatives, the antimicrobials most commonly indicated for experimental treatment (MURRAY, 2004).

Conclusion
Urinary tract infection is of public health importance. Escherichia coli is the leading cause of urinary tract infections, followed by Klebisiella pneumoniae. The resistance profile observed in our research shows how much β-lactam antibiotics and fluoroquinones need to be replaced in the clinic when it comes to the treatment of this pathology.
To establish adequate prevention and treatment of community-acquired urinary tract infections, effective and ongoing research is needed. Encouraging research on pathogen prevalence and susceptibility may be one attempt to minimize the phenomenon of bacterial resistance. Another solution to reduce bacterial resistance is to take effective measures and target self-medication.

Declarations:
Conflict of interest/Competing interest-The authors declare that they do not have conflict of interest.