Infecções relacionadas à assistência à saúde e seu impacto econômico: estudo multicêntrico em Unidades de Terapia Intensiva de adultos no Brasil

Abstract

Understanding the etiology, prevalence, and associated costs of Healthcare-Associated Infections (HAIs), is fundamental to support the development of effective control and prevention strategies within healthcare services. This study aimed to provide updated data on HAIs, particularly those of mixed nature, in adult Intensive Care Units (ICUs) in Brazil and its distinct macro-regions, with an emphasis on the analysis of associated direct costs. The study was conducted in two stages. In the first, between 2016 and 2019, data were collected from patients admitted to 57 adult ICUs of randomly selected Brazilian hospitals, in order to ensure national representativeness. These data supported a point prevalence observational study focused on evaluating the epidemiology of HAIs, including both monomicrobial and mixed infections. In the second stage, to estimate the direct costs of HAIs in adult ICUs, a Monte Carlo simulation with 50,000 iterations was used. The modeling was applied to 50 federal university hospitals in Brazil, based on a prospective economic analysis conducted with 949 critically ill patients treated in a tertiary hospital. Three HAI prevalence scenarios were considered: scenario 1 (0%), scenario 2 (9.41%), and scenario 3 (actual regional/national prevalences obtained through a multicenter study). Costs were also standardized per 100,000 inhabitants, in order to allow population comparisons among the different macroregions. Among the ICU-acquired HAI cases (N = 102 patients), 83.3% were monomicrobial infections, while 16.7% (17 patients) presented mixed infections. The Southeast and South regions concentrated the highest frequencies of ICU-acquired HAIs, with 78.1% and 77.8% of the cases, respectively. Among the microbiologically confirmed episodes (53.1%), 15.8% presented mixed etiology. Pneumonia was the most prevalent infection, representing 38% of monomicrobial episodes and 50% of mixed episodes. Gram-negative bacilli were the main etiologic agents, responsible for 55.8% of all cases and for 64.9% of mixed cases. Regarding direct costs, in a scenario without HAIs, the annual estimate for treating 27,008 adult patients in Brazilian ICUs was US$ 149,720,763. In the scenario with a 9.41% prevalence, it was observed that the values remained similar to the scenario without HAIs both at the national level and by macroregion. However, with the actual Brazilian HAI prevalence of 43.82%, costs increased by almost US$ 129 million. The Southeast region showed the highest financial burden, with an estimated direct cost of US$ 118,642,872 for a prevalence of 56.8%. Despite having 417 fewer patients than the North region, the Northeast recorded an additional cost of US$ 9,210,628 compared to the ideal scenario. The ICU bed density was 0.382322 per 100,000 inhabitants, and the costs attributable to HAIs reached US$ 214,423,126, a disproportionately high value when analyzed by macroregion and considering the availability of intensive care beds. This study provides an alarming overview of the distribution of monomicrobial and mixed infections in adult ICUs in Brazil and highlights the significant economic burden of HAIs in adult ICUs on the Brazilian healthcare system. Nevertheless, a prevalence of 9.41% of HAIs can be proposed as acceptable for Brazilian hospitals in terms of cost increase. The results emphasize the urgent need for implementing effective public health strategies aimed at reducing HAIs, in order to improve patient clinical outcomes and increase the economic efficiency of hospital services.