Resistência microbiana a antibióticos: situação nas Unidades de Pronto Atendimento de Salvador, Bahia, 2023 e 2024.

Abstract

Antimicrobial resistance (AMR) represents one of the greatest global public health threats, imposing high costs and limiting therapeutic options. In Brazil, prevention and surveillance policies are traditionally concentrated in the hospital environment, leaving a significant gap in pre-hospital emergency services, such as Emergency Care Units (ECU). These units, designed for patient care for up to 24 hours, face prolonged patient stays, structural limitations, and a lack of mandatory surveillance for Healthcare-Associated Infections (HAIs), creating a potential environment for the acquisition and dissemination of multidrug-resistant organisms (MDROs). This cross-sectional and descriptive study analyzed MDRO notifications registered by the State Infection Control Center (NECIH/DIVISA) in Bahia, Brazil, in 2023 and 2024, aiming to characterize the epidemiological profile of patients with MDROs and a prior history of care in ECU in Salvador. A total of 2,260 notifications from the city were analyzed, revealing a 47.5% increase over the period. The predominant profile was male (58.6%) and elderly individuals aged ≥ 60 years (66.7%). Most cultures (69.6%) were collected after the second day of hospitalization. Among cases with early identification (≤ 2 days), ECU emerged as the second leading source of origin (25.2% in 2023 and 26.4% in 2024), second only to other hospitals. Among the 89 cases specifically attributed to ECU, colonization predominated (78.6%). The most frequent pathogens were carbapenem-resistant Acinetobacter spp., Klebsiella spp., and Pseudomonas aeruginosa. The use of invasive devices was prevalent even among these patients. The results demonstrate that ECU are integrated into the MDRO transmission chain, acting as an entry point for these pathogens into the hospital network. It is concluded that there are critical gaps in the early detection and surveillance of AMR at the pre-hospital level, reinforcing the urgent need to integrate ECU into infection control strategies through the implementation of screening protocols, strengthening of bed regulation, and staff training, aiming to curb the spread of MDROs and enhance patient safety in the emergency care network.