Fatores de risco para infecções hospitalares em crianças críticas

• Autor(a) principal: Figueiredo, Mirza Rocha
• Data de Publicação: 2007
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/4681
• topic: Intensive carre; Invesive devices; Predictors; Nosocomial infections; Ventilator-Associated pneumonia; Cuidados intensivos; Dispositivos invasivos; Preditores; Infecção hospitalar; Pneumonia associada à ventilação mecânica; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA

The objective of this thesis is evaluate the influence of exposure to some risk factors and the occurrence of nosocomial infections (NI) and to examine risk factors for ventilator-associated pneumonia (VAP) in critically ill children. We use the prospective study was carried out on 268 children less than three years old, at a pediatric intensive care unit, from January 1997 to September 2000. Poisson regression and hierarchized multivariate analysis were performed to estimate incidence rate ratios and to identify risk factors associated to nosocomial infections. To 178 children only, who were ventilated, Cox regression was performed to estimate hazards ration and to identify risk factors for VAP. Our results were 74 nosocomial infections were diagnosed, and the overall incidence of NI cases was 48.1 per 1000 patient-days. The final model showed as predictors of nosocomial infections were age over two (incidence rate ratio [IRR]: 2.66, confidence interval [CI] 95%:1.46- 4.58), urinary tract catheter (IRR: 2.92; CI 95%: 1.47-5.8), parenteral nutrition use (IRR: 1.90; CI 95%: 1.15-3.13), bronchoscope use (IRR: 1.84; CI 95%: 1.03-3.27), central catheter s exposure time (IRR: 1,72; CI 95%: 0.94-3.15), 29 childrem (16.3%) developed VAP and the overall incidence was 29.3 per 1000 ventilator-days (OC 95%: 29.34-42.11); 50% of all cases had happened until day 5 of ventilator. The daily hazard risk increased to 2.2% at day 7, and decreased after that. Risk factors of VAP in hierarchized multivariate analysis were age over one (hazards ratio [HR]: 3.49; IC 95%: 1.64-7.45), digestive surgery (HR: 5.05; CI 95%: 2.17-11.78), parenteral nutrition (HR: 2.68; IC 95% 1.24-5.80). Exposure to antibiotics conferred protection (HR: 0.29; IC 95%: 0.13-0.65). Our conclusion is: the results suggest that the influence of the exposure time is determinant of nosocomial infection s occurrence, and it is healthcare associated in critically ill patients. Institutional politics might be aimed at prevention and control activities, as strategy to promote healthcare quality and patient safety. Public health surveillance and longitudinal studies of risk factors for ventilator-associated pneumonias can help to assess prognosis, and devise and test preventive strategies, and efforts might be concentrated on the first week of ventilation assistance.