Antimicrobial Resistance in Urinary Tract Infections in Brazil with Emphasis on the Legal Amazon
DOI:
https://doi.org/10.66104/rdj7s162Keywords:
Antimicrobial Resistance; Escherichia coli; Legal Amazon; Urinary Tract Infections.Abstract
Objective: Urinary tract infections (UTIs) are among the most frequent bacterial infections in clinical practice and represent a major public health concern due to the progressive increase in antimicrobial resistance. This study aimed to analyze the etiological profile and regional patterns of antimicrobial resistance among the main uropathogens in Brazil, with comparative emphasis on the different Brazilian regions, especially the Legal Amazon. Methods: This is an integrative literature review conducted using the PubMed/MEDLINE, SciELO, and Google Scholar databases, including studies published between 2015 and 2025 in Portuguese and English. Eighteen eligible studies containing extractable microbiological data on uropathogens isolated from urine cultures and their respective antimicrobial susceptibility and resistance profiles were selected. Data were organized, standardized, and analyzed descriptively and comparatively. Results: Escherichia coli was the main etiological agent in all analyzed regions. Higher resistance rates were observed for penicillins, antifolates, and fluoroquinolones, whereas nitrofurantoin, fosfomycin, and carbapenems showed lower resistance percentages in most studies. Conclusion: The findings demonstrate important regional differences and reinforce the need for continuous microbiological surveillance and rational antimicrobial use policies in Brazil.
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ALMEIDA, Vitelhe Ferreira de; QUILIICI, Maria Clara Bisaio; SABINO, Sebastiana Silva; RESENDE, Daiane Silva; ROSSI, Iara; CAMPOS, Paola Amaral de; RIBAS, Rosineide Marques; GONTIJO-FILHO, Paulo Pinto. Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients: a 7-year retrospective study in a referral Brazilian hospital. Sao Paulo Medical Journal, São Paulo, v. 141, n. 6, e20210933, 2023. DOI: 10.1590/1516-3180.2021.0933.R1.24022023. DOI: https://doi.org/10.1590/1516-3180.2021.0933.r1.24022023
ARIAS, C. A.; MURRAY, B. E. The rise of the Enterococcus: beyond vancomycin resistance. Nature Reviews Microbiology, London, v. 10, n. 4, p. 266–278, 2012. DOI: 10.1038/nrmicro2761. Disponível em: https://doi.org/10.1038/nrmicro2761. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1038/nrmicro2761
ARAÚJO, Sônia Maria Holanda Almeida et al. Community-acquired urinary tract bacterial infections and drug resistance among patients followed at a reference center in Fortaleza, Ceará, Brazil. Revista de Patologia Tropical, Goiânia, v. 44, n. 3, p. 245–257, 2015. DOI: 10.5216/rpt.v44i3.38013. Disponível em: https://revistas.ufg.br/index.php/iptsp/article/view/38013. Acesso em: 25 maio 2026. DOI: https://doi.org/10.5216/rpt.v44i3.38013
BRASIL. Agência Nacional de Vigilância Sanitária. Programa Nacional de Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde (PNPCIRAS) 2021–2025. Brasília: ANVISA, 2023. Disponível em: https://www.gov.br/anvisa. Acesso em: 18 maio 2026.
BRASIL. Ministério da Saúde. Resistência aos antimicrobianos. Brasília: Ministério da Saúde, 2025. Disponível em: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/r/ram. Acesso em: 25 maio 2026.
CAMPOS, Vinícius Rosendo Vieira; VIEIRA, Giovanna Santos; RAMOS, Letícia Fernanda; BAPTISTA, Anderson Barbosa. Etiological and susceptibility profile of microorganisms causing urinary tract infection in pregnant women in the city of Palmas, Brazil. Research, Society and Development, v. 11, n. 15, e200111536973, 2022. DOI: 10.33448/rsd-v11i15.36973. DOI: https://doi.org/10.33448/rsd-v11i15.36973
CASTILLO, Naiara Campos Paixão de et al. Resistência bacteriana em uroculturas de mulheres em Macapá: comparação dos resultados ambulatoriais e hospitalares. Revista Científica Multidisciplinar Núcleo do Conhecimento, ano 4, ed. 10, v. 13, p. 128–165, out. 2019. ISSN 2448-0959. Disponível em: https://www.nucleodoconhecimento.com.br/saude/resistencia-bacteriana. Acesso em: 25 maio 2026.
CASTRO, Eduardo Moreira de; BARCELLOS, Isadora Silva; SANTORO-LOPES, Guilherme; SILVA, Ana Paula de Souza da; LONGO, Luís Guilherme de Araújo; BARBOSA, Mariana Anjo; OLIVEIRA, Gabriela Camarano de; VILAR, Lucas Cecílio; FERREIRA, Adriana Lúcia Pires; MIRANDA, Karla Rodrigues; MOREIRA, Beatriz Meurer. Emergency and persistence of Escherichia coli ST131 as community-onset antimicrobial resistant urinary tract infection in Rio de Janeiro, Brazil. Brazilian Journal of Infectious Diseases, v. 29, artigo 104555, 2025. DOI: 10.1016/j.bjid.2025.104555. DOI: https://doi.org/10.1016/j.bjid.2025.104555
CENTERS FOR DISEASE CONTROL AND PREVENTION. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta: CDC, 2023. Disponível em: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html. Acesso em: 18 maio 2026.
CUNHA, M. A.; ASSUNÇÃO, G. L.; MEDEIROS, I. M.; FREITAS, M. R. Antibiotic resistance patterns of urinary tract infections in a northeastern Brazilian capital. Revista do Instituto de Medicina Tropical de São Paulo, São Paulo, v. 58, p. 2, 2016. DOI: 10.1590/S1678-9946201658002. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC4793943/. Acesso em: 25 maio 2026. DOI: https://doi.org/10.1590/S1678-9946201658002
DE OLIVEIRA, Sergio Marcelino; GONDIM DOS SANTOS, Ludimylla Lins. Infecção do trato urinário: estudo epidemiológico em prontuários laboratoriais. Journal Health NPEPS, [S. l.], v. 3, n. 1, p. 198–210, 2018. Disponível em: https://periodicos.unemat.br/index.php/jhnpeps/article/view/2843. Acesso em: 25 maio 2026.
EUROPEAN ASSOCIATION OF UROLOGY. EAU Guidelines on Urological Infections. Arnhem: European Association of Urology, 2025. Disponível em: https://uroweb.org/guidelines/urological-infections. Acesso em: 26 maio 2026.
FALAGAS, M. E. et al. Fosfomycin: use beyond urinary tract and gastrointestinal infections. Clinical Infectious Diseases, Oxford, v. 46, n. 7, p. 1069–1077, 2008. DOI: 10.1086/527442. Disponível em: https://doi.org/10.1086/527442. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1086/527442
FLORES-MIRELES, A. L. et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, London, v. 13, n. 5, p. 269–284, 2015. DOI: 10.1038/nrmicro3432. Disponível em: https://doi.org/10.1038/nrmicro3432. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1038/nrmicro3432
FONSECA, M. de Oliveira Lacerda; SOARES, C. Ramos; VALIATTI, T. Barcelos. Perfil de resistência aos antimicrobianos de Escherichia coli isoladas de infecção do trato urinário em Rondônia. Interfaces Científicas - Saúde e Ambiente, v. 9, n. 2, p. 411–423, 2023. DOI: 10.17564/2316-3798.2023v9n2p411-423. Disponível em: https://periodicos.set.edu.br/saude/article/view/11532. Acesso em: 25 maio 2026. DOI: https://doi.org/10.17564/2316-3798.2023v9n2p411-423
FOXMAN, B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North America, Philadelphia, v. 28, n. 1, p. 1–13, 2014. DOI: 10.1016/j.idc.2013.09.003. Disponível em: https://doi.org/10.1016/j.idc.2013.09.003. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1016/j.idc.2013.09.003
GUPTA, K. et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update. Clinical Infectious Diseases, Oxford, v. 52, n. 5, p. e103–e120, 2011. DOI: 10.1093/cid/ciq257. Disponível em: https://doi.org/10.1093/cid/ciq257. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1093/cid/ciq257
HIGGINS, J. P. T. et al. Manual Cochrane para Revisões Sistemáticas de Intervenções. Versão 6.5. Cochrane, 2024. Disponível em: https://www.cochrane.org/handbook. Acesso em: 18 maio 2026.
HUTTNER, A. et al. Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. Journal of Antimicrobial Chemotherapy, Oxford, v. 70, n. 9, p. 2456–2464, 2015. DOI: 10.1093/jac/dkv147. Disponível em: https://doi.org/10.1093/jac/dkv147. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1093/jac/dkv147
KRAKOVSKY, G. et al. Aminoglycoside therapy and nephrotoxicity: mechanisms and prevention strategies. International Journal of Nephrology and Renovascular Disease, Auckland, v. 10, p. 149–161, 2017. DOI: 10.2147/IJNRD.S127930. Disponível em: https://doi.org/10.2147/IJNRD.S127930. Acesso em: 18 maio 2026.
MAGIORAKOS, A. P. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions. Clinical Microbiology and Infection, Oxford, v. 18, n. 3, p. 268–281, 2012. DOI: 10.1111/j.1469-0691.2011.03570.x. Disponível em: https://doi.org/10.1111/j.1469-0691.2011.03570.x. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x
MURRAY, C. J. L. et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, London, v. 399, n. 10325, p. 629–655, 2022. DOI: 10.1016/S0140-6736(21)02724-0. Disponível em: https://doi.org/10.1016/S0140-6736(21)02724-0. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
NEGRI, Mariana; LIMA, Bárbara Martins; WOLOSZYNEK, Renata dos Santos Batista Reis; MOLINA, Roberto Augusto Silva; GERMANO, Carla Maria Ramos; MELO, Débora Gusmão; SOUZA, Leandro Cândido de; AVÓ, Lucimar Retto da Silva de. Prevalence and antimicrobial resistance profile of pathogens isolated from patients with urine tract infections admitted to a university hospital in a medium-sized Brazilian city. Revista do Instituto de Medicina Tropical de São Paulo, São Paulo, v. 66, e3, 2024. DOI: 10.1590/S1678-9946202466003. DOI: https://doi.org/10.1590/s1678-9946202466003
NICOLE, L. E. Urinary tract infections in pregnancy. Current Opinion in Infectious Diseases, Philadelphia, v. 27, n. 1, p. 76–82, 2014. DOI: 10.1097/QCO.0000000000000027. Disponível em: https://doi.org/10.1097/QCO.0000000000000027. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1097/QCO.0000000000000027
OLIVEIRA, Maria Clara F.; CANELLAS, Anna Luiza B.; BERBERT, Lidiane C.; CARDOSO, Alexander M.; SILVA, Vitoria A.; GARUTTI, Samantha S. T.; RANGEL, Débora Hosana F.; DIAS, Rubens Clayton S.; PERINI, Jamila Alessandra; SOUZA, Claudia R. V. M.; CHAGAS, Thiago P. G.; LAPORT, Marinella S.; PELLEGRINO, Flávia Lúcia P. C. Assessment of antimicrobial resistance and virulence of biofilm-forming uropathogenic Escherichia coli from Rio de Janeiro. Antibiotics, Basel, v. 14, n. 9, artigo 869, 2025. DOI: 10.3390/antibiotics14090869. DOI: https://doi.org/10.3390/antibiotics14090869
OLIVEIRA, Sergio Marcelino de; SANTOS, Ludimylla Lins Gondim dos. Infecção do trato urinário: estudo epidemiológico em prontuários laboratoriais. Journal Health NPEPS, v. 3, n. 1, p. 198-210, 2018. DOI: 10.30681/252610102843. DOI: https://doi.org/10.30681/252610102843
O’NEILL, Jim. Tackling drug-resistant infections globally: final report and recommendations. London: Review on Antimicrobial Resistance, 2016. Disponível em: https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf. Acesso em: 25 maio 2026.
PAN AMERICAN HEALTH ORGANIZATION. Report signals increasing resistance to antibiotics in bacterial infections in humans and need for better data. Washington, DC: Pan American Health Organization, 2022. Disponível em: https://www.paho.org/en/news/9-12-2022-report-signals-increasing-resistance-antibiotics-bacterial-infections-humans-and. Acesso em: 26 maio 2026.
PATERSON, D. L.; BONOMO, R. A. Extended-spectrum beta-lactamases: a clinical update. Clinical Microbiology Reviews, Washington, v. 18, n. 4, p. 657–686, 2005. DOI: 10.1128/CMR.18.4.657-686.2005. Disponível em: https://doi.org/10.1128/CMR.18.4.657-686.2005. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1128/CMR.18.4.657-686.2005
PERFIL etiológico e de suscetibilidade de microrganismos causadores de infecção do trato urinário em gestantes na cidade de Palmas, Brasil. Pesquisa, Sociedade e Desenvolvimento, [S. l.], v. 11, n. 15, p. e200111536973, 2022. DOI: 10.33448/rsd-v11i15.36973. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/36973. Acesso em: 25 maio 2026.
PETER, Claudia Rejane Mews; BRAGA, Josiane Cristine dos Passos Krause; RODRIGUES, Lourdes Helena de Araújo; ARRIEIRA, Mauricio Parcio; ARRIEIRA, Rafael de Oliveira; BÖHLKE, Maristela. Padrão de resistência antimicrobiana em culturas ambulatoriais de urina em mulheres no sul do Brasil: comunicação breve de um estudo transversal. Revista Gaúcha de Enfermagem, v. 43, e20200485, 2022. DOI: 10.1590/1983-1447.2022.20200485.pt. DOI: https://doi.org/10.1590/1983-1447.2022.20200485.pt
PINHO, F. J. A. de; LOPES, M. B.; PRIMEIRA, V. K. M. J. B. G. de M.; RUBIRA, A. P. F. de A.; TAVARES, L. C. O perfil epidemiológico da resistência bacteriana em pacientes diagnosticados com ITU num município de Rondônia. Contribuciones a las Ciencias Sociales, [S. l.], v. 18, n. 11, p. e22472, 2025. DOI: 10.55905/revconv.18n.11-287. Disponível em: https://ojs.revistacontribuciones.com/ojs/index.php/clcs/article/view/22472. Acesso em: 25 maio 2026. DOI: https://doi.org/10.55905/revconv.18n.11-287
REDGRAVE, L. S. et al. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends in Microbiology, Cambridge, v. 22, n. 8, p. 438–445, 2014. DOI: 10.1016/j.tim.2014.04.007. Disponível em: https://doi.org/10.1016/j.tim.2014.04.007. Acesso em: 18 maio 2026. DOI: https://doi.org/10.1016/j.tim.2014.04.007
REIS, A. C.; SANTOS, S. R.; SOUZA, S. C.; SALDANHA, M. G.; PITANGA, T. N.; OLIVEIRA, R. R. Ciprofloxacin resistance pattern among bacteria isolated from patients with community-acquired urinary tract infection. Revista do Instituto de Medicina Tropical de São Paulo, São Paulo, v. 58, p. 53, 2016. DOI: 10.1590/S1678-9946201658053. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC4964322/. Acesso em: 25 maio 2026. DOI: https://doi.org/10.1590/S1678-9946201658053
REOLOM, Ricardo Pretto; KLAFKE, André. Resistência antimicrobiana em uroculturas de moradores das Zonas Norte e Nordeste de Porto Alegre. Revista Brasileira de Medicina de Família e Comunidade, Rio de Janeiro, v. 17, n. 44, artigo 3067, 2022. DOI: 10.5712/rbmfc17(44)3067. DOI: https://doi.org/10.5712/rbmfc17(44)3067
ROCHA, Rudi; CAMARGO, Marcela; FALCÃO, Lucas; SILVEIRA, Mariana; THOMAZINHO, Gabriela. A saúde na Amazônia Legal: evolução recente e desafios em perspectiva comparada. São Paulo: Instituto de Estudos para Políticas de Saúde; Amazônia 2030, 2021. Disponível em: https://amazonia2030.org.br/wp-content/uploads/2021/11/A-Saude-na-Amazonia-Legal.pdf. Acesso em: 25 maio 2026. DOI: https://doi.org/10.59346/report.amazonia2030.202111.ed20
SANTOS, Julio César Abreu dos; GUEDES, Adriano Kemmerich; FONTES, Juliana Loca Furtado. Infecção do trato urinário e gestação: caracterização e perfil de resistência dos micro-organismos isolados de pacientes em um centro obstétrico de referência na Amazônia Ocidental. RevistaFT, v. 29, ed. 149, ago. 2025. DOI: 10.69849/revistaft/fa10202508042301. Disponível em: https://revistaft.com.br/infeccao-do-trato-urinario-e-gestacao-caracterizacao-e-perfil-de-resistencia-dos-micro-organismos-isolados-de-pacientes-em-um-centro-obstetrico-de-referencia-na-amazonia-ocidental/. Acesso em: 25 maio 2026. DOI: https://doi.org/10.69849/revistaft/fa10202508042301
SAUNDERS, Yandra Giovanna de Oliveira Cunha; BRITO, Élis Mariângela Souza de; LIMA, Valeria Paes; NORONHA, Elza Ferreira. Perfil das infecções do trato urinário em mulheres adultas em acompanhamento ambulatorial no Hospital Universitário de Brasília no período pandêmico de COVID-19. Revista Foco, Curitiba, v. 17, n. 3, e4661, p. 1-18, 2024. DOI: 10.54751/revistafoco.v17n3-141. DOI: https://doi.org/10.54751/revistafoco.v17n3-141
SILVA, Carlos Eduardo da; CARVALHO, Pedro Henrique Silva; CAPRETZ, Gabriel Cunha Garcia; CIRIACO, Yasmin de Souza; SOUZA, Wesley Henrique Macedo de; ALVES, Maria Eduarda Figueiredo Severiano; BORGES, Breno Medeiros; RIBEIRO, Gustavo Machado; CARMO, Mateus Henrique do; ABREU, Milena Cristina Faria; HIGUCHI, Eunice; MANZANO, João Pádua; CANDIDO, Patrícia; REIS, Sabrina T. Profile of antimicrobial resistance of uropathogens in urinary tract infections: an analysis of 1117 hospitalized patients in Brazil. IJID Regions, v. 16, artigo 100724, 2025. DOI: 10.1016/j.ijregi.2025.100724. DOI: https://doi.org/10.1016/j.ijregi.2025.100724
TANO, Zuleica Naomi; KOBAYASHI, Renata K.; CANDIDO, Evelyn Poliana; DIAS, Juliana Buck; PERUGINI, Luis Felipe; VESPERO, Eliana Carolina; PAVANELLI, Wander Rogerio. Susceptibility to first choice antimicrobial treatment for urinary tract infections to Escherichia coli isolates from women urine samples in community South Brazil. Brazilian Journal of Infectious Diseases, v. 26, n. 3, artigo 102366, 2022. DOI: 10.1016/j.bjid.2022.102366. DOI: https://doi.org/10.1016/j.bjid.2022.102366
WORLD HEALTH ORGANIZATION. Global antibiotic resistance surveillance report 2025: WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). Geneva: World Health Organization, 2025. Disponível em: https://www.who.int/publications/i/item/9789240116337. Acesso em: 26 maio 2026.
WORLD HEALTH ORGANIZATION. Global action plan on antimicrobial resistance. Geneva: World Health Organization, 2015. Disponível em: https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf. Acesso em: 26 maio 2026.
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Copyright (c) 2026 Lucas Wagner Pereira de Souza , Nicolle Juliana Ximendes Gadelha Alves, Nieggy Schuindt Galdino, Siandra Cordeiro Alves , Adriana Cristina Dutra Capila , Jerônimo Vieira Dantas Filho, Rosineide Vieira Gois

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