Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean

Abstract

This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

“…Resistance rates are even higher in eastern and southern Europe, Latin America, and many Asian countries. Overall, the proportion of global XDR strains of A. baumannii has increased from Ͻ4% in 2000 to Ͼ60%, while the proportion of XDR strains of A. baumannii in some regional nosocomial settings has more recently approached 90% (27,31,35,42,43,(183)(184)(185)(186)(187)(188)(189)(190).…”

Early detection and control of an Acinetobacter baumannii multi-resistant outbreak in a hospital in Quito, Ecuador

“…Outbreaks caused by ABA-MDR have been described worldwide [1][2][3][4][5][6][7]13] yet few studies in the literature refer to Latin America [8]. The few manuscripts investigating adult ICU Gram-negative outbreaks in Latin America and the Caribbean mostly originate from the more affluent nations.…”

“…The few manuscripts investigating adult ICU Gram-negative outbreaks in Latin America and the Caribbean mostly originate from the more affluent nations. No such publications from Ecuador have been found, leaving the scientific community blind to the mortality and morbidity rates associated with these nosocomial outbreaks and the effectiveness of ensuing outbreak management in the distinctive contexts of this Latin American country [4,8].…”

“…In Latin America, few outbreak studies of ABA have been published, the first being in Brazil in 2003 [4]. The situation of MDR ABA is of particular concern in developing countries, such as Ecuador, where the conditions and policies of hospitals are not always up to date, leading to increases in the risk of nosocomial infections [8].…”

Genetic relatedness of clinical and environmental Acinetobacter baumanii isolates from an intensive care unit outbreak

“…These non-fermentative, Gram-negative bacteria commonly exist in nature and have the ability to survive for prolonged periods in dry environmental conditions. Infections in critically ill patients in intensive care units (ICU) are common and often associated with occurrence of outbreaks [1,2]. With the emergence of multidrug resistant strains, this organism continues to pose a significant threat in critical care units particularly in settings where successful clones have become endemic [3][4][5][6].…”