Clinical outcome of patients colonized and infected by multidrug-resistant bacteria in a private hospital in Fortaleza/Ceará, in 2021




Antimicrobials; Mortality; Colonization; Bacterium; Infection.


The COVID-19 pandemic, since 2019, has contributed to aggravating situations that increase the risk of colonization or infection by multidrug-resistant bacteria, such as the indiscriminate use of antimicrobials. The aim of this study was to investigate the relationship between bacterial resistance and negative clinical outcome. A cross-sectional and retrospective study was carried out, where data were collected from the medical records of patients hospitalized in different hospital units (ICU, ward, isolation and neonatology units), from January to December 2021. Inclusion criteria were patients reported with colonization or infection by multidrug-resistant bacteria during hospitalization and with complete data. There were 128 positive samples, with a mean age of 68.2 years. There was a statistically significant difference in mortality when comparing patients younger than 50 years and the age groups between 70-80 years (p=0.006) and above 80 years (p=0.03). Among the three main pathogens isolated and their high mortality rate, there was no statistically significant difference in terms of the overall mortality rate for Acinetobacter baumannii (p = 0.54), Klebsiella pneumoniae (p = 1) and Pseudomonas aeruginosa (p = 1). = 0.82). A statistically significant result was detected for mortality and use of quinolones (p = 0.047) and a trend towards significance for polymyxin (p = 0.09). It was concluded that there was high mortality in patients colonized or infected by multidrug-resistant bacteria in a hospital setting, mainly over 70 years old. The use of quinolones, aminoglycosides and polymyxin seems to be related to higher mortality.

Author Biographies

Cicero Allan Landim de Oliveira Lima, Hospital São José

R3 of Infectious Diseases at the Hospital São José for Infectious Diseases, emergency physician with experience in the Intensive Care Unit.

Ana Lívia Gomes Moreira, Hospital São José

Infectologist and coordinator of the Infectious Diseases Infirmary at Hospital São José, professor at the Unichristus School of Medicine and Coordinator of the SCIH at Santa Casa de Fortaleza.

Rafael Ferreira Mesquita, Hospital São Camilo Fortaleza; Hospital São José

Infectologist and coordinator of the Infectious Diseases Infirmary at Hospital São José and Coordinator of SCIH at Hospital São Camilo in Fortaleza.

Luan Victor Almeida Lima, Hospital São José; Centro Universitário Unichristus

Doctor R3 of Infectious Diseases at Hospital São José, working in the ward and emergency room. Master's Student of the Master's Program in Teaching and Health at Unichristus (Mested)

Bruno Pinheiro Aquino, Hospital São José; Centro Universitário Unichristus

Infectologist at Hospital Sao Jose and Coordinator of Infectious Diseases Infirmary, Master's Student of the Health Education Program at Unichristus (MESTED)


ANVISA, Nota Técnica GVIMS/GGTES/ANVISA No 05/2021; Orientações para prevenção e controle da disseminação de microrganismos multirresistentes em serviços de saúde no contexto da pandemia da COVID-19 – 02/08/2021.

Barbier, F., Pommier, C., Essaied, W., Garrouste-Orgeas, M., Schwebel, C., Ruckly, S., Dumenil, A. S., Lemiale, V., Mourvillier, B., Clec'h, C., Darmon, M., Laurent, V., Marcotte, G., Lucet, J. C., Souweine, B., Zahar, J. R., Timsit, J. F., & OUTCOMEREA Study Group (2016). Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? The Journal of antimicrobial chemotherapy, 71(4), 1088–1097.

Bassetti, M., Merelli, M., Temperoni, C., & Astilean, A. (2013). New antibiotics for bad bugs: where are we? Annals of clinical microbiology and antimicrobials, 12, 22.

Bassetti, M., & Righi, E. (2015). New antibiotics and antimicrobial combination therapy for the treatment of gram-negative bacterial infections. Current opinion in critical care, 21(5), 402–411.

Bassetti, M., & Righi, E. (2015). Development of novel antibacterial drugs to combat multiple resistant organisms. Langenbeck's archives of surgery, 400(2), 153–165.

Bertolini, G., Nattino, G., Tascini, C., Poole, D., Viaggi, B., Carrara, G., Rossi, C., Crespi, D., Mondini, M., Langer, M., Rossolini, G. M., & Malacarne, P. GiViTI Steering Committee. (2018). Mortality attributable to different Klebsiella susceptibility patterns and to the coverage of empirical antibiotic therapy: a cohort study on patients admitted to the ICU with infection. Intensive care medicine, 44(10), 1709–1719.

Boucher, H. W., Talbot, G. H., Bradley, J. S., Edwards, J. E., Gilbert, D., Rice, L. B., Scheld, M., Spellberg, B., & Bartlett, J. (2009). Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clinical infectious Diseases: an official publication of the Infectious Diseases Society of America, 48(1), 1–12.

Costa, A. L. P. (2016) Resistência Bacteriana aos Antibióticos: Uma Perspectiva Do Fenômeno Biológico, Suas Consequencias e Estratégias De Contenção. 63 f. Trabalho de Conclusão de Curso (Graduação em Biologia) – Curso de Ciências Biológicas, Departamento de Ciências Biológicas e da Saúde, UNIFAP, Macapá.

Da Silva, H. R., Rocha, A. S. C., Rocha, M. V. S., Veras, D. M., de Sousa, O. M. C., Sousa, G. C., Almeida, D. F., de Oliveira, A. L. P., Bezerra, G. S. S., Ribeiro, D. A. S., Pereira, N. M., Alves, A. K. R., Alves, A. K. R., da Silva, B. B. L., Nogueira, F. D., Rodrigues, S. L. D., & Pessoa, G. T. (2020). Reflection of environmental imbalance in health: multi-resistant bacteria in hospital environment. Research, Society and Development, 9(8), e220985604.

De Carvalho, J. J. V., Boaventura, F. G., da Silva, A. C. R., Ximenes, R. L., Rodrigues, L. K. C., Nunes, D. A. A., & de Souza, V. K. G. (2021). Bactérias multirresistentes e seus impactos na saúde pública: Uma responsabilidade social. Research, Society and Development, 10(6), e58810616303

De Queiroz, G. M., da Silva, L. M., Pietro, R. C. L. R., & Salgado, H. R. N. (2012). Multirresistência microbiana e opções terapêuticas disponíveis / Microbial multi-resistance and available therapeutic options. Rev Bras Clin Med. 10(2), 132-8.

Gabriel, A. C. G., Pinheirp, D. H. P., Fernnades, L. M. S., Wind, M. M., Ferreira, V. R., & Pereira, M. S. (2021). Colonization profile and microbiological resistance in Intensive Care Unit (ICU) patients in the city of Anápolis – GO. Research, Society and Development, 10(16), e588101623853

Gurgel, T. C., & Carvalho, W. S. (2018). A Assistência Farmacêutica e o Aumento da Resistência Bacteriana aos Antibióticos. Latin American Journal of Pharmacy, 27(1), 118-123

Kollef, M. H., Shorr, A. F., Bassetti, M., Timsit, J. F., Micek, S. T., Michelson, A. P., & Garnacho-Montero, J. (2021). Timing of antibiotic therapy in the ICU. Critical care (London, England), 25(1), 360.

Langford, B. J., So M., Raybardhan S., Leung V., Soucy J. R., Westwood D., Daneman N., MacFadden, D. R. (2021). Antibiotic prescribing in patients with COVID- 19: rapid review and meta-analysis. Clinical Microbiology and Infection, 27, 520e531.

Lakbar, I., Medam, S., Ronflé1, R., Cassir, N., Delamarre, L., Hammad, E., Lopez, A., Lepape, A., Machut, A., Boucekine, M., Zieleskiewicz, L., Baumstarck, K., Savey, A., Leone, M. & REA RAISIN Study Group. (2021). Association between mortality and highly antimicrobial‐resistant bacteria in intensive care unit‐acquired pneumonia. Nature Scientific Reports, 11:16497

Machado, G. M., Lago, A., Fuentefria, S. R. R. & Fuentefria, D. B. (2011). Occurrence and the susceptibility to antimicrobial agents in Pseudomonas aeruginosa and Acinetobacter sp. at a tertiary hospital in southern Brazil. Rev. Soc. Bras. Med. Trop. 44(2), 168-172.

Mota, F. S., Oliveira, H. A., & Souto, R. C. F. (2018). Perfil e prevalência de resistência aos antimicrobianos de bactérias Gram-negativas isoladas de pacientes de uma unidade de terapia intensiva. RBAC. 50(3):270-7. DOI: 10.21877/2448-3877.201800740

Nascimento, C. K. R., Santos, M. M., Oliveira, P. M. C., Iomori, M. V. A. H., Santos, R. M. M., Martins, V. B. D., Melo, B. F., Nascimento, A. L. L., Santos, I. S. P., Dias, T. C., Santos, M. H. S., Rodrigues, A. A., Bezerra, M. S. L., Andrade, R. S. B., & Santos, S. C. (2021). Microbiological and immunological aspects related to the colonization and infection of patients by resistant Acinetobacter baumannii in nosocomial environment. Research, Society and Development, v. 10, n. 2, e25910212650

Queenan, K., Hasler, B. J. & Rushton, A. (2014). One Health approach to antimicrobial resistance surveillance: is there a business case for it? International Journal of Antimicrobial Agents, Volume 48(4).

Ranganathan, P., & Aggarwal, R. (2018). Study designs: Part 1 - An overview and classification. Perspectives in clinical research, 9(4), 184–186.

Razazi, K., Mekontso Dessap, A., Carteaux, G., Jansen, C., Decousser, J. W., de Prost, N., & Brun-Buisson, C. (2017). Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae. Annals of intensive care, 7(1), 61.

Santos, I. A. L., Nogueira, J. M. R. & Mendonça, F. C. R. (2015). Mecanismos de resistência antimicrobiana em Pseudomonas aeruginosa. RBAC. 47(1-2), 512.

Souza, E. E. S., Almeida, A. G. C. S., de Souza, C. D. F., Nagliate, P. C., Borges, K. R., & Junges, A. V. (2021). Microbial resistance profile of infections related to health care in a hospital for infectious diseases in a capital of Northeastern Brazil. Research, Society and Development, 10(4), e39910414198.

Vincent, J. L., Sakr, Y., Singer, M., Loeches, I. M., Machado, F. R., Marshall, J. C, Finfer, S. Pelosi, P., Brazzi, L., Aditianingsih, D., Timsit, J. F., Du, B., Wittebole, X., Máca, J., Kannan, S., Delsol, L. A. G., Waele, J. J. D., Mehta, Y., Bonten, M. J. M., Khanna, A. K., Kollef, M., Human, M., & Angus, D. C. (2020). Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 323(15):1478–1487. 10.1001/jama.2020.2717.

WHO, New report calls for urgent action to avert antimicrobial resistance crisis. 2019.

Zeng, L., Yang, C., Zhang, J., Hu, K., Zou, J., Li, J., Wang, J., Huang, W., Yin, L. & Zhang, X. (2021). An Outbreak of Carbapenem- Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China. Frontiers in Cellular and Infection Microbiology, June, Volume 11, Article 656070.



How to Cite

LIMA, C. A. L. de O. .; MOREIRA, A. L. G. .; MESQUITA, R. F. .; LIMA, L. V. A. .; AQUINO, B. P. .; MEDEIROS, M. S. . Clinical outcome of patients colonized and infected by multidrug-resistant bacteria in a private hospital in Fortaleza/Ceará, in 2021. Research, Society and Development, [S. l.], v. 11, n. 2, p. e58611226032, 2022. DOI: 10.33448/rsd-v11i2.26032. Disponível em: Acesso em: 21 jun. 2024.



Health Sciences