Infecções relacionadas à assistência a saúde baseada em critérios internacionais, realizada em unidade neonatal de cuidados progressivos de referência de Belo Horizonte, MG
Abstract:The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA).
“…Nine studies [ 59 – 61 , 64 – 66 , 69 – 71 ] provided data on the incidence of HA neonatal sepsis in NICUs, expressed as cases per 1000 NICU-treated neonates. The pooled incidence of HA neonatal sepsis was 112.9 cases (95% CI 64.2–191.1%) per 1000 NICU-treated neonates (Fig.…”
Section: Resultsmentioning
confidence: 99%
“…5 b; Supplementary material 2, Table 4). The pooled estimate for blood culture-proven cases, a subgroup of HA neonatal sepsis cases, was 45.7 (95% CI 26.0–79.2, range 20.5–75.6) cases per 1000 NICU-treated neonates (five studies [ 59 , 65 , 66 , 69 , 70 ]) and accounted for 25.0% (95% CI 15.9–37.0%, range 16.5–50.7%)) of all HAIs. Fig.…”
Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospitalacquired (HA) and ICU-acquired (ICU-A) sepsis. Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low-and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.
“…Nine studies [ 59 – 61 , 64 – 66 , 69 – 71 ] provided data on the incidence of HA neonatal sepsis in NICUs, expressed as cases per 1000 NICU-treated neonates. The pooled incidence of HA neonatal sepsis was 112.9 cases (95% CI 64.2–191.1%) per 1000 NICU-treated neonates (Fig.…”
Section: Resultsmentioning
confidence: 99%
“…5 b; Supplementary material 2, Table 4). The pooled estimate for blood culture-proven cases, a subgroup of HA neonatal sepsis cases, was 45.7 (95% CI 26.0–79.2, range 20.5–75.6) cases per 1000 NICU-treated neonates (five studies [ 59 , 65 , 66 , 69 , 70 ]) and accounted for 25.0% (95% CI 15.9–37.0%, range 16.5–50.7%)) of all HAIs. Fig.…”
Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospitalacquired (HA) and ICU-acquired (ICU-A) sepsis. Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low-and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.
“…Of a total of 5596 citations identified, 138 met the criteria for abstract review and 52 met the criteria for full-text assessment, of which 15 met the inclusion criteria for this review, namely, Kawagoe, JY et al 2001 [ 16 ]; Nagata, E et al 2002 [ 17 ]; Pessoa-Silva, CL et al 2004 [ 18 ]; Couto, RC et al 2007 [ 19 ]; Távora, AC et al 2008 [ 20 ]; Pereira, SM et al 2009 [ 21 ]; Catarino, CF et al 2012 [ 22 ]; Dal-Bó, K et al 2012 [ 23 ]; Freitas, BA et al 2012 [ 24 ]; Ventura, CM et al 2012 [ 25 ]; Romanelli, RM et al 2013 [ 26 ]; da Silva, AR et al 2013 [ 27 ]; de Souza Rugolo, LM et al 2014 [ 28 ]; Urzedo, JE et al 2014 [ 29 ]; Freitas, FTM et al 2019 [ 30 ] (Fig. 2 ).…”
Background
Healthcare-associated infections (HAI) are important causes of neonatal morbidity and mortality in developing countries. We reviewed the incidence and the pathogens involved in HAI among infants admitted to neonatal intensive care units (NICU) in Brazil.
Methods
A search was conducted in the MEDLINE, LILACS and SciELO databases from January 1995 to October 2019. Two authors scrutinized potential articles independently, after one author selected them from screening abstracts from every article flagged as related to neonatal HAI. Then, they were included in the review if they met our inclusion criteria. The studies were evaluated based on a quality score proposed by the authors, rated 0 to 1, with 1 point as the best quality rate. Pooled estimates and 95% confidence intervals (95% CI) for HAI cumulative incidence and incidence density were calculated, when the same denominators were available, using meta-analysis. A quality effect was applied to the models using the MetaXL software. Heterogeneity was assessed using I2 statistics and the Cochran’s Q test.
Results
Of a total of 5596 citations identified, 15 studies met the inclusion criteria for this review, which comprised 24,408 patients and 312,744 patient-days. Quality of the studies varied between 0.36 and 1 according to the adopted score, and six (40.0%) studies presented a score of 1. Pooled HAI incidence was 36.1 (95% CI 22.8–50.7) infections and 26.3 (95% CI 18.4–35.0) infected patients per 100 patients. Pooled HAI incidence density was 23.5 (95% CI 16.3–33.9) per 1000 patient-days. Pooled incidence density rates of bloodstream infection and ventilator-associated pneumonia were 13.1 per 1000 catheter-days (95% CI 4.3–40.1) and 7.9 per 1000 ventilator-days (95% CI 1.1–55.5), respectively. A high degree of heterogeneity was observed in all models (I2 > 98% and Cochran’s Q test with p < 0.05). Coagulase-negative Staphylococci (32.1%), Staphylococcus aureus (13.8%) and Klebsiella spp. (12.4%) were the most prevalent causative bacterial pathogens.
Conclusions
The findings show high incidence of neonatal HAI in Brazilian NICU; therefore, efforts to standardize the collection and notification of HAI are needed in order to strengthen surveillance in the country and implement preventive measures, routine assessment, and close monitoring of neonates.
“…[...] foi possível avaliar que o venoso central de inserção periférica (55,6%) e o cateter umbilical venoso (22,2%) foram os mais utilizados, estando diretamente ligados à infecção. E3 (10).…”
Section: Recomendações Para Controle E Prevenção Das Infecções Relaciunclassified
Objetivo: descrever as principais características das infecções hospitalares em Unidade de Terapia Intensiva Neonatal. Metodologia: Estudo descritivo de revisão de literatura, que utilizou a busca eletrônica, nas bases de dados científicas e análise e interpretação dos dados com base na Análise de Conteúdo de Bardin. Resultado: Delimitaram-se três categorias: Tipos de transmissão das Infecções Relacionadas à Assistência à Saúde em neonatos; Principais microrganismos presentes nas infecções em neonatos; e Recomendações para controle e prevenção de infecções em neonatos. Verificou-se que a transmissão destas infecções dividem-se em transplacentárias; precoce, de provável origem materna; e tardias, de origem hospitalar. Dentre os microrganismos mais relatados na literatura estão o Staphylococcus coagulase negativa, Staphylococcus aureus, Klebsiela pneumoniae, Candida sp e Pseudomonas aeruginosa. E as principais formas de controle e prevenção envolvem a lavagem, o uso controlado de antimicrobianos e a orientação aos pais e responsáveis quanto ao manuseio do neonato. Conclusões: Tais constatações podem contribuir para a ampliação do conhecimento dos profissionais que atuam nas Unidades de Terapias Intensivas Neonatais, possibilitando uma assistência de qualidade aos recém-nascidos.Palavras chaves: Assistência à saúde. Infecção. Infecção Hospitalar. Unidade de Terapia Intensiva Neonatal.
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