Introduction. Bloodstream infection is one of the most frequent and challenging hospital-acquired infections and it is associated with high morbidity, mortality and additional use of healthcare resources. Hypothesis/Gap Statement: Bloodstream infections have consequences for the patient, such as the evolution to mortality and inappropriate empirical antibiotic prescription, especially when caused by multidrug-resistant Gram-negative bacilli. Objective. To assess the impact of bloodstream infection and the status of multidrug resistance (MDR) in the evolution of patients who received inappropriate initial antibiotic therapy. Methods. A retrospective surveillance was conducted on nosocomial bloodstream infections caused by Gram-negative bacilli (GNB) from January 2012 to December 2018 in an adult intensive care unit of a Brazilian tertiary teaching hospital. Results. We identified 270 patients with GNB nosocomial bacteremia. Non-survivors were older (with an average age of 58.8 years vs 46.9 years, P=<0.0001), presented more severe illnesses, were immunosuppressed (73.7 vs 37.6%, P=<0.0001), were more likely to have septic shock (55.8 vs 22.4%, P=<0.0001) and had an increased usage of mechanical ventilators (98.6 vs 89.6%, P=0.0013) than survivors. In a logistic regression model, inappropriate empirical antibiotic therapy was not an independent predictor of mortality, different from mechanical ventilator (P=<0.0001; OR=28.0; 95% CI=6.3–123.6), septic shock (P=0.0051; OR=2.5; 95% CI=1.3–4.9) and immunosuppression (P=0.0066; OR=2.6; 95% CI=1.3–5.2). In contrast, in a separate model, MDR was strongly associated with the prescription of inappropriate initial antibiotic therapy (P=0.0030; OR=5.3; 95% CI=1.7–16.1). The main isolated pathogens were Acinetobacter baumannii (23.6 %) and Klebsiella pneumoniae (18.7 %). The frequency of MDR organisms was high (63.7 %), especially among non-fermenting bacilli (60.9 %), highlighting A. baumannii (81.6 %) and Pseudomonas aeruginosa (41.8 %). Conclusion. Illness severity (septic shock and immunosuppression) and mechanical ventilation were identified as predictors of mortality. Additionally, MDR was a major determinant of inappropriate antibiotic empirical therapy, but not associated with mortality, and both characteristics were not statistically associated with death.
Introdução: A pneumonia associada à ventilação mecânica (PAV) é uma infecção pulmonar que se desenvolve em uma pessoa que está sob uso do ventilador. A incidência em hospitais brasileiros pode variar de 23,2% a 50% nas Unidades de Terapia Intensiva. Objetivo: Reunir, sintetizar e integrar resultados de estudos primários que investigaram a importância da adoção de cuidados de enfermagem. Material e métodos: Utilizou-se a revisão integrativa e a pesquisa foi realizada em bases de dados eletrônicas na área da saúde. Os descritores utilizados foram: “Pneumonia associada à ventilação mecânica”, “Higiene oral” e “Enfermagem”. Foram incluídos 8 estudos na amostra. Resultados: Os profissionais de enfermagem reconhecem a importância das medidas de prevenção contra a PAV, apesar de não ter muita adesão. Esses cuidados apresentam impacto positivo quando são realizados. Dentre as principais está a higiene oral. Conclusão: A PAV tem uma elevada frequência nas Unidades de Terapia Intensiva em diversos hospitais do país. Para que essa ocorrência diminua é necessária à adoção de medidas preventivas que estejam incluídas na rotina dos cuidados de enfermagem, dentre os procedimentos, a higiene oral é a que mais se destaca.Palavras-chave: pneumonia associada à ventilação mecânica, higiene bucal, Enfermagem.
Objective: To establish a baseline of knowledge regarding about inappropriate therapy, virulence and resistance in a cohort of patients infected with S. aureus. Methods: Retrospective cohort study in tertiary-care university hospital was employed to evaluate the risk factors and the impact of inappropriate therapy among patients with Staphylococcus aureus infections, resistance and virulence. To assess the presence of the genes was performed PCR. Results: Patients with MRSA were older and hospitalized 17 days longer than those with MSSA infection, which were in ICU with a bloodstream infection. 50.0% received inadequate antibiotic therapy and we found virulence factors associated with MRSA (mecA, LukS, fnbB and clfA genes). Conclusion: These data show that surveillance studies related to Staphylococcus aureus infections remain essential to identify resistance and inform policy on resistance.
Vigilância Epidemiológica e mortalidade de pacientes críticos com bacteremia por Bacilos Gram-Negativos internados em Hospital terciário de grande porte no Brasil [recurso eletrônico] / Maria Clara Bisaio Quillici.-2020.
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