Estudo das infecções invasivas por Staphylococcus aureus em crianças internadas na UTI pediátrica de um hospital público durante o período de 20 anos

Abstract

This work describes and analyzes epidemiological, clinical and microbiological aspects of Staphylococcus aureus infections in children hospitalized in a pediatric ICU (PICU). We review of medical records of patients aged 29 days to 12 years admitted to the PICU with invasive staphylococcal disease in the period from 13 August 1989 to 13 August 2009. We analyzed the records of 83 patients (1.8% of 4597 admissions) with invasive disease caused by S. aureus. The age ranged from 1m to 12.4 years (mean 4 years) and 47 (56.6%) patients were male. There were predominance of the community-acquired infections (61 cases, 73.5%) and the most frequent diagnoses were pneumonia (especially in children under five years) and osteo-arthritis (in the oldest) with or without sepsis. Most patients showed no comorbidity at admission and when present they were the postoperative condition, presence of central venous catheter, skin lesions and immunodeficiencies. The main indications for admission to the PICU were respiratory failure and cardiovascular. The most common sources of agent isolation were blood, pleural fluid and osteo-articular secretion. The most frequently used antibiotics were oxacillin, vancomycin and ceftriaxone, with or without aminoglycosides. The overall death rate of 27.7% was lower than that of hospital infections (45.5%) and those caused by MRSA (66.6%).The disagreement between the employed and antibiotic susceptibility testing resulted in no significant difference in mortality (p = .25). Despite the low frequency of the invasive staphylococcal disease, the mortality is high. The study of the clinical-epidemiological aspects of the disease and in vitro resistance of the agent contributes to the early diagnosis and the initial empirical antibiotic therapy.