Prevalência e desfechos das infecções nas UTIs brasileiras: mais uma peça no quebra-cabeça...

Abstract

Infection prevalence and outcomes in BraziliansICUs: another brick in the wall.. Prevalência e desfechos das infecções nas UTIs brasileiras: mais uma peça no quebra-cabeça... EDITORIALInfections significantly influence the morbidity and mortality rates of intensive care units (ICUs), and the prevalence and impact of severe infections in critically ill patients have increased progressively in recent years. (1,2) In addition, more than 70% of critically ill patients admitted to ICUs are prescribed an antimicrobial agent during their stay. (1) Unfortunately, the actual situation in Brazil is difficult to assess because high-quality data on the local conditions are scarce in the literature. The few studies that sought to retrieve Brazilian data on infections and sepsis reported extremely important results, showing that both the prevalence and the lethality associated with infection in critically ill patients is high compared to the values reported in the international literature. For instance, the mortality rate of patients in Brazil with septic shock is greater than 50%. (3)(4)(5) The reasons underlying such unfavorable outcomes are unclear; however, organizational issues and early detection are certainly important features in such an assessment.This issue of the Brazilian Journal of Intensive Care (Revista Brasileira de Terapia Intensiva -RBTI) includes an article that is crucial for a better understanding of the current status of sepsis and infections in critically ill patients. (6) This study performed a sub-analysis of EPIC II (Extended Prevalence of Infection in Intensive Care), which is a cross-sectional study that included 13,796 patients, more than 9,000 patients who received antimicrobial agents and approximately 7,000 patients who were diagnosed as infected. The sub-analysis assessed only patients in Brazil and provides precise, high-quality data on the prevalence and characteristics of the patients admitted to Brazilian ICUs. More than 1,200 patients admitted to 90 ICUs across Brazil were included for analysis in this sub-analysis, which is currently the largest study of its type in the literature.Some data in the cross-sectional study are worth noting. Approximately 62% of the patients admitted to Brazilian ICUs presented with clinical evidence of infection; this prevalence is significantly higher than the prevalences reported by the same database for other areas, such as Europe and North America (where the prevalence is less than 50%). (1) In addition to higher prevalence, our ability to identify the etiology of infection is poor; thus, the pathogens that were potentially responsible for the infection were isolated in only 50% of the cases. The most frequent site of infection was the respiratory system (61%). The distribution of the pathogens associated with infection in Brazilian ICUs is also worth noting for several reasons. Brazil has a higher prevalence of Gram-negative agents compared to other

Prevalência de infecção hospitalar em unidade de terapia intensiva - um estudo retrospectivo

“…Estes fatores podem contribuir fortemente não apenas para o alto índice de IH em Unidade de Terapia Intensiva (UTI), mas também para a alta prevalência de morbimortalidade, sendo necessário que a equipe de enfermagem e saúde sejam detentoras de conhecimentos indispensáveis sobre o controle de infecções. [3][4] O diagnóstico de infecção hospitalar é feito com base em alguns critérios clínicos que servem como norteadores. Nessa direção, a premissa inicial para que um caso de infecção seja considerado nosocomial é averiguar se as manifestações clínicas iniciaram há, no mínimo, 72 horas após sua admissão hospitalar.…”