Estudo Multicêntrico de Infecções Relacionadas à Assistência à Saúde em Unidades de Terapia Intensiva de Adultos no Estado de Minas Gerais, Brasil

Abstract

Introduction: Healthcare-associated infections (HAIs) and high antibiotic use are a challenge to public health, especially in countries with few resources such as Brazil, where there are social inequalities and important variations in the complexity of health care and regional development. Objectives: To provide data on the differences in the prevalence and anatomical distribution of HAIs, their etiology, resistance profile and antimicrobial use in patients hospitalized in Adults Intensive Care Units (ICUs) at hospitals of different sizes in the planning regions of Minas Gerais, Brazil, using a point prevalence survey. Methods: In 2016, a one-day point prevalence survey was carried out on 35 Adults ICUs, including 28 clinical-surgical ICUs and seven coronary ICUs at hospitals in the 10 planning regions of the state of Minas Gerais (Alto Paranaíba, Central, Centro-Oeste de Minas, Jequitinhonha/Mucuri, Mata, Noroeste de Minas, Norte de Minas, Rio Doce, Sul de Minas and Triângulo), located in the Southeast region of Brazil. Hospitals were classified as university or non-university hospitals and hospitals with ≤ 200 beds, 201-400 beds and > 400 beds. All patients admitted to the ICUs during the period of the research were included in the study. Results: A total of 303 patients admitted to clinical-surgical ICUs were included, of which 155 (51.2%) were infected and 123 patients had acquired at least one infection in the ICU (79.4%). The infections most frequently acquired in the ICUs were pneumonia (53.0%) and bloodstream infection (27.6%). In total, 119 bacterial samples were observed as the HAIs' cause, with a higher frequency of Acinetobacter baumannii (27.0%), Pseudomonas aeruginosa (27.0%) and Staphylococcus aureus (39.1%). Pseudomonas aeruginosa (30.4%) was the main pneumonia agent; coagulase-negative Staphylococcus (23.4%) and micro-organisms of the Enterobacteriaceae family (23.4%) were responsible for bloodstream infections, whereas the most common pathogens in urinary tract infections were Enterobacteriaceae (47.6%) and Candida spp. (38.1%). In the coronary Adults ICUs, 71 patients were evaluated, and the prevalence of HAIs was 22.5% (16/71), and those acquired in the ICU were 68.8% (11/16). The most frequent infections in these units were also pneumonia (34.8%), followed by bloodstream infection (30.4%). Among the 374 hospitalized patients, 232 (62.0%) received at least one antimicrobial, most without microbiological culture, with a higher frequency in non-university hospitals. The results also detected a high consumption of broad-spectrum antibiotics, mainly cephalosporins, more frequent in non-university hospitals (64.4%), and polymyxins, more frequent in university hospitals (65.0%). Conclusions: This multi centric study revealed a very high prevalence of infections acquired in ICUs, when comparing Brazilian ICUs to ICUs in most European countries and in the US. In general, these infections are mainly caused by Gram-negative bacteria associated with pneumonia. Antimicrobial use was also observed in most of the patients, with empirical prescription and with an emphasis on the ones with broad-spectrum. The polymyxins use was also observed, thus contributing, as well as justifying, the significant frequency of higher resistance/multi-resistance in these units. Our data identify the urgent need for Brazil's public health agenda to prioritize HAIs as well as the use of antibiotics. They also identify the need to introduce surveillance, prevention and control programs to target epidemiological indicators of morbidity, mortality, and costs.