Estudo multicêntrico de infecção de corrente sanguínea e pneumonia nosocomial em pacientes internados em UTI’s de adultos no estado de Minas Gerais

Abstract

Introduction: There is a lack of multi-centre reports acknowledging the importance of healthcare-associated infections (HAIs) in Brazilian intensive care units (ICUs). These severe infections correspond to the most recurrent adverse event in hospitals worldwide and represent an important public health problem. In this study we described the burden of nosocomial pneumonias and bloodstream infection (BSIs), the trends in device-associated healthcare-associated infections (DA-HAIs), as well as the prevalence and etiology of polymicrobial infections in this scenario. Aim: To provide an up-to-date picture of the burden of HAIs, DA-HAIs, and polymicrobial infections, as well as to identify variables associated with the risk of development of these severe infections. Methodology: 24-hour point-prevalence surveys were conducted using standardized protocols in 35 adult (medical-surgical and coronary) ICUs from 8 mesoregions of Minas Gerais State, Brazil. Medical records of eligible inpatients were reviewed on the survey day to collect data regarding demographic characteristics, HAI rates present at the time of the survey, device use, length of stay from 374 patients and bacterial profiles, and all relevant data associated with the epidemiology of these infections. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed, and the data regarding DA-HAIs were analyzed to disclose patterns of invasive device use associated with these infections. Results: Overall 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9% and 80.3%, respectively, were acquired in the ICU. The etiology of them was predominated by Gram-negative bacteria versus Gram-positive bacteria (48.9% versus 43.3%), highlighting Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%). Among the DA-HAIs (42.5%), there were 78.8% of central line-associated bloodstream infections (CLABSIs), 71.5% of ventilator-associated pneumonias (VAPs) and 54.2% of catheter-associated urinary tract infections (CAUTIs). The invasive devices frequencies were 70.1% for central venous catheter (CVC), 48.9% for mechanical ventilation (MV) and 64.4% for indwelling urinary catheters (IUC). The most frequent pathogens associated with DA-HAIs were Pseudomonas aeruginosa (14.7%) and Acinetobacter baumanni (15.7%). Conclusion: We can endorse a high severe ICU-acquired HAIs burden as well as high frequencies of medical invasive device use in Brazilian adult ICUs when compared with findings from other low- and middle-income countries. And unfortunately, polymicrobial infections presented a frequency of 23.8%, with 41.2% caused by Gram-negative bacilli. These data can be utilized for better planning of nosocomial infection surveillance programs in our hospitals.