Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos

Detalhes bibliográficos
Autor(a) principal: Gomides, Mabel Duarte Alves
Data de Publicação: 2021
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UFU
Texto Completo: https://repositorio.ufu.br/handle/123456789/31889
http://doi.org/10.14393/ufu.te.2021.216
Resumo: 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.
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spelling Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicosAnalysis of the relation between colonization and infection by carbapenem-resistant enterobacteriaceaeKlebsiella pneumoniaeInfecções NosocomiaisUnidade de Terapia IntensivaVigilânciaControle de InfecçõesAntibióticosHealth Care Associated InfectionsIntensive Care UnitsSurveillanceInfection controlAnti-Bacterial AgentsCNPQ::CIENCIAS DA SAUDEEnterobactériasAntibióticosIntroduction: 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.Tese (Doutorado)Introdução: As colonizações e infecções por enterobacteriáceas resistentes aos carbapenêmicos (CRE - carbapenem-resistant Enterobacteriaceae) têm aumentado de forma ameaçadora, com predomínio da Klebsiella pneumoniae resistente aos carbapenêmicos (CRKP - carbapenem-resistant Klebsiella pneumoniae), apesar da implementação das medidas de controle e prevenção. Consequentemente, tem sido observado aumento na incidência de infecções relacionadas à assistência à saúde (IRAS), morbimortalidade e tempo de hospitalização. A colonização por CRE e fatores de risco, como: pacientes graves, internação prolongada, dispositivos invasivos e exposição prévia aos antibióticos, podem favorecer a infecções invasivas por CRE. A disseminação da CRE ocorre, principalmente, em ambientes hospitalares, por transmissão cruzada entre pacientes e profissionais de saúde ou em ambientes contaminados. A colonização representa um risco na disseminação das CRE, e a detecção isolada das infecções é, apenas, a ponta do iceberg. Portanto, a vigilância ativa é uma importante estratégia para a detecção de CRE, e permite controlar a propagação dessas bactérias resistentes. Objetivos: Objetivou-se demonstrar a importância do protocolo de vigilância ativa CRE e avaliar as taxas e prevalências, os fatores de risco e a mortalidade nos colonizados e infectados por CRKP, além de traçar um perfil da colonização, infecção e mortalidade, ao longo de cinco anos. Material e Métodos: Realizou-se um estudo observacional e retrospectivo em hospital público, no sudeste do Brasil. Foram analisados um total de 1.920 pacientes maiores de 12 anos, internados na unidade de terapia intensiva (UTI), de janeiro/2014 a dezembro/2018. Todos os pacientes foram submetidos ao protocolo de vigilância ativa com teste de triagem para CRE, por meio de swab retal. Resultados: Entre todos os 1.920 pacientes, a média de idade foi de 52,42 ± 19,34 anos (variação de 13 a 97 anos), com predomínio do sexo masculino (65,31%). sobre o sexo feminino (1,88:1). A alta (68,12%) foi um desfecho mais predominante do que a morte (2,13:1). O escore SAPS II variou de 16 a 131 (média 62,19 ± 18,73). O tempo médio de internação foi de 21,03 ± 18,12 dias (intervalo de 1 a 175 dias). Os testes de triagem CRE foram positivos em 10,91% das coletas de swab retal com 13,66% de coletas positivas nos mesmos pacientes. A análise de prevalência da colonização, infecção e mortalidade para CRE, com predomínio para CRKP, foi elevada na UTI. Observou-se uma chance elevada (OR 7,967) de pacientes colonizados evoluírem com infecção invasiva para CRE. Os fatores de risco mais prevalentes para os colonizados por CRE e infectados por CRKP foram traqueostomia e exposição prévia aos antibióticos. Conclusões: A detecção de pacientes colonizados para CRE, por meio dos testes de triagem, mostrou ser um importante instrumento no controle de infecções e colonizações. Visto que permite a implantação precoce de medidas que controlam a propagação de bactérias resistentes. Contudo, ao longo dos cinco anos, demonstrou-se que as taxas e prevalências de CRE nos pacientes colonizados e infectados por CRKP mantiveram-se elevadas. Ressalta-se, portanto, a necessidade de reavaliar o protocolo de vigilância ativa de CRE, desta UTI, além do excesso de coletas de triagem e uso empírico de antibióticos.2023-03-31Universidade Federal de UberlândiaBrasilPrograma de Pós-graduação em Ciências da SaúdeSadoyama, Geraldohttp://lattes.cnpq.br/5245055964402823Ferreira, Anderson Luizhttp://lattes.cnpq.br/9495326031912899Rodrigues, Alex Mirandahttp://lattes.cnpq.br/4306715524442111Vieira, José Daniel Gonçalveshttp://lattes.cnpq.br/1742731776579730Pedroso, Reginaldo dos Santoshttp://lattes.cnpq.br/4934313736553945Brito, Denise Von Dolinger dehttp://lattes.cnpq.br/5521478892510854Gomides, Mabel Duarte Alves2021-06-08T12:08:34Z2021-06-08T12:08:34Z2021-03-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfGOMIDES, Mabel Duarte Alves. Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos. 2021. 97 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2021. DOI http://doi.org/10.14393/ufu.te.2021.216.https://repositorio.ufu.br/handle/123456789/31889http://doi.org/10.14393/ufu.te.2021.216porhttp://creativecommons.org/licenses/by-nc-nd/3.0/us/info:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFUinstname:Universidade Federal de Uberlândia (UFU)instacron:UFU2024-04-09T15:23:25Zoai:repositorio.ufu.br:123456789/31889Repositório InstitucionalONGhttp://repositorio.ufu.br/oai/requestdiinf@dirbi.ufu.bropendoar:2024-04-09T15:23:25Repositório Institucional da UFU - Universidade Federal de Uberlândia (UFU)false
dc.title.none.fl_str_mv Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
Analysis of the relation between colonization and infection by carbapenem-resistant enterobacteriaceae
title Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
spellingShingle Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
Gomides, Mabel Duarte Alves
Klebsiella pneumoniae
Infecções Nosocomiais
Unidade de Terapia Intensiva
Vigilância
Controle de Infecções
Antibióticos
Health Care Associated Infections
Intensive Care Units
Surveillance
Infection control
Anti-Bacterial Agents
CNPQ::CIENCIAS DA SAUDE
Enterobactérias
Antibióticos
title_short Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
title_full Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
title_fullStr Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
title_full_unstemmed Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
title_sort Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos
author Gomides, Mabel Duarte Alves
author_facet Gomides, Mabel Duarte Alves
author_role author
dc.contributor.none.fl_str_mv Sadoyama, Geraldo
http://lattes.cnpq.br/5245055964402823
Ferreira, Anderson Luiz
http://lattes.cnpq.br/9495326031912899
Rodrigues, Alex Miranda
http://lattes.cnpq.br/4306715524442111
Vieira, José Daniel Gonçalves
http://lattes.cnpq.br/1742731776579730
Pedroso, Reginaldo dos Santos
http://lattes.cnpq.br/4934313736553945
Brito, Denise Von Dolinger de
http://lattes.cnpq.br/5521478892510854
dc.contributor.author.fl_str_mv Gomides, Mabel Duarte Alves
dc.subject.por.fl_str_mv Klebsiella pneumoniae
Infecções Nosocomiais
Unidade de Terapia Intensiva
Vigilância
Controle de Infecções
Antibióticos
Health Care Associated Infections
Intensive Care Units
Surveillance
Infection control
Anti-Bacterial Agents
CNPQ::CIENCIAS DA SAUDE
Enterobactérias
Antibióticos
topic Klebsiella pneumoniae
Infecções Nosocomiais
Unidade de Terapia Intensiva
Vigilância
Controle de Infecções
Antibióticos
Health Care Associated Infections
Intensive Care Units
Surveillance
Infection control
Anti-Bacterial Agents
CNPQ::CIENCIAS DA SAUDE
Enterobactérias
Antibióticos
description 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.
publishDate 2021
dc.date.none.fl_str_mv 2021-06-08T12:08:34Z
2021-06-08T12:08:34Z
2021-03-31
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv GOMIDES, Mabel Duarte Alves. Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos. 2021. 97 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2021. DOI http://doi.org/10.14393/ufu.te.2021.216.
https://repositorio.ufu.br/handle/123456789/31889
http://doi.org/10.14393/ufu.te.2021.216
identifier_str_mv GOMIDES, Mabel Duarte Alves. Análise da relação colonização e infecção por enterobactérias resistentes aos carbapenêmicos. 2021. 97 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2021. DOI http://doi.org/10.14393/ufu.te.2021.216.
url https://repositorio.ufu.br/handle/123456789/31889
http://doi.org/10.14393/ufu.te.2021.216
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language por
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eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de Uberlândia
Brasil
Programa de Pós-graduação em Ciências da Saúde
publisher.none.fl_str_mv Universidade Federal de Uberlândia
Brasil
Programa de Pós-graduação em Ciências da Saúde
dc.source.none.fl_str_mv reponame:Repositório Institucional da UFU
instname:Universidade Federal de Uberlândia (UFU)
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instname_str Universidade Federal de Uberlândia (UFU)
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reponame_str Repositório Institucional da UFU
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