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Antibioterapia das Infeções por Klebsiella pneumoniae
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Abstract(s)
As doenças infeciosas de etiologia bacteriana foram sempre um grave problema para a sociedade, não só pela sua fácil e rápida propagação, como pela elevada mortalidade e morbilidade. Após a descoberta da penicilina, em 1928, verificou-se um desenvolvimento exponencial de novos fármacos capazes de combater as infeções bacterianas, sendo a descoberta dos antibióticos um dos avanços científicos mais importantes do século XX. No entanto, com a massificação da sua utilização, muitas vezes inapropriada, a eficácia destes fármacos tem vindo a diminuir ao longo dos anos.
A Klebsiella pneumoniae pertence à família Enterobacteriaceae e é reconhecida há muito tempo como um agente causador de doenças, descrito pela primeira vez por Carl Friedländer, em 1882, como causa de pneumonia. Na última década emergiu como uma grande ameaça clínica e de saúde pública devido ao aumento de infeções ligadas a estirpes multirresistentes associadas aos cuidados de saúde, produtoras de β-lactamases e/ou carbapenemases de espetro alargado, permanecendo, de acordo com o Programa Nacional de Prevenção das Resistências aos Antimicrobianos no grupo das bactérias mais comuns e mais problemáticas a nível mundial.
Em Portugal, a taxa de K. pneumoniae resistente aos carbapenemos tem aumentado progressivamente de 2,0% para 11,6%, entre 2012 e 2020, sendo atualmente, a 7.ª taxa mais elevada entre os países europeus participantes na rede de monitorização.
Esta bactéria pode causar diversos tipos de infeções, como pneumonia, infeções do trato urinário, septicémia e infeção da pele e tecidos moles, entre outras. No que diz respeito à antibioterapia, destacam-se os β-lactâmicos, sendo os carbapenemos a última linha de atuação. Outras opções terapêuticas incluem os aminoglicosídeos, a tigeciclina, a eravaciclina, as fluoroquinolonas, o cotrimoxazol e, como última opção, a colistina.
O farmacêutico, enquanto profissional de saúde e especialista do medicamento, poderá contribuir para alcançar os objetivos terapêuticos delineados, incluindo a melhoria na qualidade de vida dos utentes. Com efeito, a sua intervenção deve centrar-se na otimização dos benefícios da farmacoterapia e na gestão da doença, na prevenção e controlo de infeções e na promoção do uso racional de antibióticos.
Infectious diseases of bacterial aetiology have always been a serious problem for society, not only because of their easy and rapid spread, but also because of their high mortality and morbidity. After the discovery of penicillin in 1928, there was an exponential development of new drugs capable of combating bacterial infections, with the discovery of antibiotics being one of the most important scientific advances of the 20th century. However, with the widespread use of these drugs, often inappropriately, the effectiveness of these drugs has been decreasing over the years. Klebsiella pneumoniae belongs to the Enterobacteriaceae family and has long been recognized as a disease-causing agent, first described by Carl Friedländer, in 1882 as a cause of pneumonia. In the last decade, it has emerged as a major clinical and public health threat due to the increase in infections linked to multidrug-resistant strains associated with healthcare, producing β-lactamases and/or extended-spectrum carbapenemases, remaining, according to the National Program of Prevention of Antimicrobial Resistance in the group of the most common and most problematic bacteria worldwide. In Portugal, the rate of carbapenem-resistant K. pneumoniae has progressively increased from 2.0% to 11.6%, between 2012 and 2020, currently being the 7th highest rate among European countries participating in the monitoring network. This bacterium can cause different types of infections, such as pneumonia, urinary tract infections, septicaemia and skin and soft tissue infections, among others. Regarding antibiotherapy, β-lactams stand out, with carbapenems being the last line of action. Other therapeutic options include aminoglycosides, tigecycline, eravacycline, fluoroquinolones, co-trimoxazole and, as a last option, colistin. The pharmacist, as a health professional and medicinal product specialist, can contribute to achieving the outlined therapeutic objectives, including improving the quality of life of patients. Indeed, its intervention should focus on optimizing the benefits of pharmacotherapy and disease management, preventing and controlling infections, and promoting the rational use of antibiotics.
Infectious diseases of bacterial aetiology have always been a serious problem for society, not only because of their easy and rapid spread, but also because of their high mortality and morbidity. After the discovery of penicillin in 1928, there was an exponential development of new drugs capable of combating bacterial infections, with the discovery of antibiotics being one of the most important scientific advances of the 20th century. However, with the widespread use of these drugs, often inappropriately, the effectiveness of these drugs has been decreasing over the years. Klebsiella pneumoniae belongs to the Enterobacteriaceae family and has long been recognized as a disease-causing agent, first described by Carl Friedländer, in 1882 as a cause of pneumonia. In the last decade, it has emerged as a major clinical and public health threat due to the increase in infections linked to multidrug-resistant strains associated with healthcare, producing β-lactamases and/or extended-spectrum carbapenemases, remaining, according to the National Program of Prevention of Antimicrobial Resistance in the group of the most common and most problematic bacteria worldwide. In Portugal, the rate of carbapenem-resistant K. pneumoniae has progressively increased from 2.0% to 11.6%, between 2012 and 2020, currently being the 7th highest rate among European countries participating in the monitoring network. This bacterium can cause different types of infections, such as pneumonia, urinary tract infections, septicaemia and skin and soft tissue infections, among others. Regarding antibiotherapy, β-lactams stand out, with carbapenems being the last line of action. Other therapeutic options include aminoglycosides, tigecycline, eravacycline, fluoroquinolones, co-trimoxazole and, as a last option, colistin. The pharmacist, as a health professional and medicinal product specialist, can contribute to achieving the outlined therapeutic objectives, including improving the quality of life of patients. Indeed, its intervention should focus on optimizing the benefits of pharmacotherapy and disease management, preventing and controlling infections, and promoting the rational use of antibiotics.
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Keywords
Klebsiella pneumoniae Infeções associadas aos cuidados de saúde Mecanismos de resistência Antibioterapia Farmacêutico hospitalar