Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos

Abstract

Introduction: The Colonization and infections by carbapenem-resistant Enterobacteriaceae (CRE) have increased in a threatening manner, with a predominance of carbapenem-resistant Klebsiella pneumoniae (CRKP), despite the implementation of control and prevention measures. Consequently, there is an increase in the incidence of healthcare-associated infections (HAI), morbidity and mortality, and long-term hospital stay. CRE colonization along with other risk factors, such as critically ill patients, long-term hospital stay, invasive devices, and previous antibiotic exposure can result in CRE invasive infections. Transmission of CRE occurs mainly within hospital environments, especially in ICU, due to cross-transmission between patients and healthcare professionals, or through contaminated environments. Colonization represents a CRE dissemination threat, and the isolated detection of infections is only the “tip of the iceberg”. Therefore, active surveillance is an important strategy for CRE detection and allows to obtain control of the spread of these resistant bacteria. Objectives: This study aimed to demonstrate the importance of active CRE surveillance protocols and to assess rates and prevalence, risk factors, and mortality in colonized and CRKP infected patients. This study also aims to outline a colonization, infection, and mortality profile over a five-year time. Material and Methods: Retrospective, observational study of a public tertiary hospital in southeastern Brazil. A total of 1,920 patients older than 12 years were analyzed, admitted to an intensive care unit (ICU) from January 2014 to December 2018. All patients were submitted to the active surveillance protocol with a CRE screening test through a rectal swab. Results: Among all 1,920 patients, the mean age was 52.42 ±19.34 years (range 13–97 years), and there was a predominance of the male (65.31%). over the females (1.88:1) sex. Discharge (68.12%) was a more predominant outcome than death (2.13:1). The SAPS II score ranged from 16 to 131 (mean 62.19 ±18.73). The mean length of hospital stay was 21.03 ±18.12 days (range 1 – 175 days). CRE screening tests were positive in 10.91% of rectal swab collections with 13.66% of positive collections in the same patients. The analysis of the prevalence of colonization, infection, and mortality for CRE, with a predominance of CRKP, was high in the ICU. A high chance (OR 7.967) of colonized patients evolve to a CRE invasive infection was observed. The most prevalent risk factors for CRE colonized and CRKP infected were tracheostomy and previous antibiotic exposure. Conclusion: Detection of CRE colonized patients, through screening tests, proved to be an important instrument in the control of infections and colonization. Since it allows the early implementation of measures that control the spread of resistant bacteria. However, over the five years, it has been shown that the rates and prevalence of CRE in the colonized and infected with CRKP patients remained high. Therefore, the need to reevaluate the active surveillance protocol of this ICU is highlighted, in addition to the excess of screening collections and empirical use of antibiotics.