Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Research, Society and Development |
Texto Completo: | https://rsdjournal.org/index.php/rsd/article/view/13516 |
Resumo: | Urinary Tract Infections (UTI) affecting patients at Intensive Care Units (ICU) is a preoccupant reality, further aggravated by inadequate antimicrobial use and the alarming antimicrobial resistance in microorganisms. We evaluated the level of assertiveness regarding the use of antimicrobials during the empirical antibiotic-therapy (EA), in patients with UTI, comparing the empiric pharmacological treatments (EA) and those ones performed after the antibiogram (guided therapy). Moreover, we estimated the prevalence of the causative agents and analyzed the risk factors associated. This is an observational and cross-sectional study, undertaken in 2015, in which patients (both gender and all ages) with UTI and underwent antimicrobial therapy, enrolled at an ICU in a hospital in the southern region of the Brazilian state of Minas Gerais, Brazil, were evaluated. Among the 49 patients evaluated (28 females [F] and 21 males [M]), the mean age was 55±19 years (CI(95) 49-61) and the predominant age range was ≥70 years. Fourteen different microorganisms were identified. 28.3% (CI(95%) 16.2-40.4) of the UTI had Escherichia coli as causative agent (33.3% M and 28.6% F); 18.9% (CI(95%) 8.3-29.4) Acinetobacter baumannii (33.3% M and 10.7% F); 15.1% (CI(95%) 5.5-24.7) Klebsiella pneumoniae (19% M and 14.3% F); 11.3% Pseudomonas aeruginosa (9.5% M and 14.3% F); 5.7% Enterobacter aerogenes (14.3% M); 3.8% Klebsiella oxytoca; 3.8% Staphylococcus aureus (7.1% F); and 2% for each of the microorganisms as follows: Enterococcus faecalis (4.8% M); Proteus mirabilis (3.6% F); Enterobacter cloacae (3.6% F); Providencia rettgeri (4.8% M); Citrobacter koseri (3.6% F); Citrobacter freundii (3.6% F); and Yeasts (4.8% M). The prevalence of UTI caused by A. baumannii and P. aeruginosa in the ITUs were influenced by the patients’ sex (χ² with p<0.001). In the male sex, it there was “substantial” positive correlations between the most increased ages (in years) and the prevalence of UTI caused by E. coli (r = 0.69) or between the decreased ages and the prevalence of UTI caused by A. baumannii (r = -0.7). In the female sex, it there was an “extremely” positive correlation between the most increased ages and the prevalence of UTI caused by E. coli (r = 0.94; CI(95) 0.66-0.99; p<0.0014). The most used antimicrobials in an empirical fashion (EA) were: Ciprofloxacin (14.3% CI(95%) 4.7-24.1), Cefepime (14.3%), and Vancomicin (10%); and after antibiogram (guided therapy): Ceftazidime (16.3% CI(95%) 6-26.7), Ciprofloxacin (14.3% CI(95%) 4.5-24.1), Polymyxin B (10.2%), Imipenem (10.2%), and Ampicillin/sulbactam (8.2%). In 20% of cases, the EAs were considered “inappropriate/not correct”. However, we must also be aware of the clinical need and the immediacy for the treatment of UTIs in an ICU, since the disease can be fatal if a therapy is not instituted, therefore, we advise more detailed assessments, both of the rationality of use antibiotics, as well as the risk factors for the development of UTIs in ICUs. |
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Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit Factores de riesgo y perfil del uso de antimicrobianos en pacientes con infección del tracto urinario en una unidad de cuidados intensivosFatores de risco e perfil do uso de antimicrobianos entre pacientes com infecção no trato urinário em uma unidade de terapia intensivaInfecção no Trato UrinárioUnidade de Terapia IntensivaAntibióticoEscherichia coliITUUTIAcinetobacter baumannii.Infección del tracto urinarioUnidad de cuidados intensivosAntibióticoEscherichia coliAcinetobacter baumannii.Urinary tract infectionsIntensive Care UnitsAntimicrobialEscherichia coliUTIICUAcinetobacter baumannii.Urinary Tract Infections (UTI) affecting patients at Intensive Care Units (ICU) is a preoccupant reality, further aggravated by inadequate antimicrobial use and the alarming antimicrobial resistance in microorganisms. We evaluated the level of assertiveness regarding the use of antimicrobials during the empirical antibiotic-therapy (EA), in patients with UTI, comparing the empiric pharmacological treatments (EA) and those ones performed after the antibiogram (guided therapy). Moreover, we estimated the prevalence of the causative agents and analyzed the risk factors associated. This is an observational and cross-sectional study, undertaken in 2015, in which patients (both gender and all ages) with UTI and underwent antimicrobial therapy, enrolled at an ICU in a hospital in the southern region of the Brazilian state of Minas Gerais, Brazil, were evaluated. Among the 49 patients evaluated (28 females [F] and 21 males [M]), the mean age was 55±19 years (CI(95) 49-61) and the predominant age range was ≥70 years. Fourteen different microorganisms were identified. 28.3% (CI(95%) 16.2-40.4) of the UTI had Escherichia coli as causative agent (33.3% M and 28.6% F); 18.9% (CI(95%) 8.3-29.4) Acinetobacter baumannii (33.3% M and 10.7% F); 15.1% (CI(95%) 5.5-24.7) Klebsiella pneumoniae (19% M and 14.3% F); 11.3% Pseudomonas aeruginosa (9.5% M and 14.3% F); 5.7% Enterobacter aerogenes (14.3% M); 3.8% Klebsiella oxytoca; 3.8% Staphylococcus aureus (7.1% F); and 2% for each of the microorganisms as follows: Enterococcus faecalis (4.8% M); Proteus mirabilis (3.6% F); Enterobacter cloacae (3.6% F); Providencia rettgeri (4.8% M); Citrobacter koseri (3.6% F); Citrobacter freundii (3.6% F); and Yeasts (4.8% M). The prevalence of UTI caused by A. baumannii and P. aeruginosa in the ITUs were influenced by the patients’ sex (χ² with p<0.001). In the male sex, it there was “substantial” positive correlations between the most increased ages (in years) and the prevalence of UTI caused by E. coli (r = 0.69) or between the decreased ages and the prevalence of UTI caused by A. baumannii (r = -0.7). In the female sex, it there was an “extremely” positive correlation between the most increased ages and the prevalence of UTI caused by E. coli (r = 0.94; CI(95) 0.66-0.99; p<0.0014). The most used antimicrobials in an empirical fashion (EA) were: Ciprofloxacin (14.3% CI(95%) 4.7-24.1), Cefepime (14.3%), and Vancomicin (10%); and after antibiogram (guided therapy): Ceftazidime (16.3% CI(95%) 6-26.7), Ciprofloxacin (14.3% CI(95%) 4.5-24.1), Polymyxin B (10.2%), Imipenem (10.2%), and Ampicillin/sulbactam (8.2%). In 20% of cases, the EAs were considered “inappropriate/not correct”. However, we must also be aware of the clinical need and the immediacy for the treatment of UTIs in an ICU, since the disease can be fatal if a therapy is not instituted, therefore, we advise more detailed assessments, both of the rationality of use antibiotics, as well as the risk factors for the development of UTIs in ICUs.La Infección del Tracto Urinario (ITU) que afecta a pacientes en Unidades de Cuidados Intensivos (UCI) es una realidad preocupante, agravada por el uso irracional de antimicrobianos y la alarmante multirresistencia de los microorganismos. Se evaluó el nivel de asertividad respecto al uso de antimicrobianos durante la antibioticoterapia empírica (ATE), en pacientes diagnosticados de ITU, comparando este tratamiento farmacológico empírico y el realizado tras el antibiograma (antibioticoterapia dirigida), además, estimamos la prevalencia de los agentes etiológicos y analizamos los factores de riesgo asociados. Se trata de un estudio observacional y transversal, realizado en 2015, con pacientes de ambos sexos y todas las edades afectado por ITU y sometidos a antibioticoterapia, ingresados en una UCI de un hospital del sur de Minas Gerais, Brasil. De los 49 pacientes evaluados (28 mujeres [M] y 21 hombres [H]), la edad media fue 55 ± 19 años (IC(95) 49-61) y el grupo de edad ≥70 años fue el predominante. Catorce microorganismos diferentes causaron ITU, con el 28,3% (IC(95) 16,2-40,4) de los aislados clínicos que tenían Escherichia coli como agente etiológico (33,3% H y 28,6% M); el 18,9% (IC(95) 8,3-29,4) Acinetobacter baumannii (33,3% H y 10,7% M); el 15,1% (IC(95) 5,5-24,7) Klebsiella pneumoniae (19% H y 14,3% M); el 11,3% Pseudomonas aeruginosa (9,5% H y 14,3% M); el 5,7% Enterobacter aerogenes (14,3% H); el 3,8% Klebsiella oxytoca; el 3,8% Staphylococcus aureus (7,1% M); y el 1,9% para cada uno de los siguientes microorganismos: Enterococcus faecalis (4,8% H); Proteus mirabilis (3,6% M); Enterobacter cloacae (3,6% M); Providencia rettgeri (4,8% H); Citrobacter koseri (3,6% M); Citrobacter freundii (3,6% M); y hongos similares a las levaduras (4,8% H). La prevalencia de ITU causada por A. baumannii y P. aeruginosa fue influenciada por el sexo (χ² con p <0.001). En los hombres, hubo correlaciones positivas "sustanciales" entre el aumento de la edad (en años) y la prevalencia de ITU causada por E. coli (r = 0,69) o entre edades menos avanzadas y la prevalencia de ITU causada por A. baumannii (r = -0,7). En las mujeres, hubo una correlación positiva “extremadamente fuerte” entre el aumento de la edad y la prevalencia de ITU causada por E. coli (r = 0,94; IC(95) 0,66-0,99; p <0,0014). Los antibióticos más utilizados empíricamente (ATE) fueron: Ciprofloxacino (14,3% IC(95) 4,7-24,1), Cefepima (14,3%) y Vancomicina (10%), y tras el antibiograma (tratamiento antibiótico dirigido): Ceftazidima (16,3%) IC(95) 6-26,7), Ciprofloxacina (14,3% IC(95) 4,5-24,1), Polimixina B (10,2%), Imipenem (10,2%) y Ampicilina + Sulbac. (8,2%). En el 20% de los casos, las terapias empíricas (ATE) se consideraron “inapropiadas/incorrectas”. Sin embargo, también debemos ser conscientes de la necesidad clínica y la inmediatez para el tratamiento de una ITU en una UCI, ya que la enfermedad puede ser fatal si no se instituye una terapia, por lo que aconsejamos valoraciones más detalladas, tanto de la racionalidad de utilizar antibióticos, así como los factores de riesgo para el desarrollo de infecciones urinarias en UCI.A Infecção no Trato Urinário (ITU) acometendo pacientes em Unidades de Terapia Intensiva (UTIs) é uma realidade preocupante, agravada pelo uso irracional de antimicrobianos e a alarmante multirresistência em microrganismos. Nós avaliamos o nível de assertividade quanto ao uso de antimicrobianos durante à antibioticoterapia empírica (ATE), em pacientes diagnosticados com ITU, comparando tal tratamento farmacológico empírico e o realizado após o antibiograma (antibioticoterapia direcionada), além disto, estimamos a prevalência dos agentes etiológicos e analisamos os fatores de risco associados. Este é um estudo observacional e transversal, realizado em 2015, no qual foram avaliados pacientes de ambos os sexos e todas as idades apresentando ITU e submetidos à antibioticoterapia, internados em uma UTI de um hospital no sul de Minas Gerais, Brasil. Dos 49 pacientes avaliados (28 mulheres [M] e 21 homens [H]), a média de idade foi 55±19 anos (IC(95) 49-61) e a faixa etária ≥70 anos foi a predominante. Quatorze diferentes microrganismos foram causadores de ITUs, sendo que 28,3% (IC(95%) 16,2-40,4) dos isolados clínicos tiveram Escherichia coli como o agente etiológico (33,3% H e 28,6% M); 18,9% (IC(95%) 8,3-29,4) Acinetobacter baumannii (33,3% H e 10,7% M); 15,1% (IC(95%) 5,5-24,7) Klebsiella pneumoniae (19% H e 14,3% M); 11,3% Pseudomonas aeruginosa (9,5% H e 14,3% M); 5,7% Enterobacter aerogenes (14,3% H); 3,8% Klebsiella oxytoca; 3,8% Staphylococcus aureus (7,1% M); e 1,9% para cada um dos seguintes microrganismos: Enterococcus faecalis (4,8% H); Proteus mirabilis (3,6% M); Enterobacter cloacae (3,6% M); Providencia rettgeri (4,8% H); Citrobacter koseri (3,6% M); Citrobacter freundii (3,6% M); e Fungos leveduriformes (4,8% H). As prevalências de ITUs causadas por A. baumannii e P. aeruginosa foram influenciadas pelo sexo (χ² com p<0,001). No sexo masculino, houve correlações positivas “substanciais” entre o aumento da idade (em anos) e a prevalência de ITU causada por E. coli (r = 0,69) ou entre idades menos avançadas e a prevalência de ITU causada por A. baumannii (r = -0,7). No sexo feminino, houve uma correlação positiva “extremamente forte” entre o aumento da idade e a prevalência de ITU causada por E. coli (r = 0,94; IC(95) 0,66-0,99; p<0,0014). Os antibióticos mais utilizados de forma empírica (ATE) foram: Ciprofloxacina (14,3% IC(95%) 4,7-24,1), Cefepima (14,3%) e Vancomicina (10%), e após o antibiograma (antibioticoterapia direcionada): Ceftazidima (16,3% IC(95%) 6-26,7), Ciprofloxacina (14,3% IC(95%) 4,5-24,1), Polimixina B (10,2%), Imipenem (10,2%) e Ampicilina + Sulbac. (8,2%). Em 20% dos casos, as terapias empíricas (ATE) foram consideradas “inapropriadas/não acertadas”. Contudo, também devemos ter ciência da necessidade clínica e quanto ao imediatismo para o tratamento de uma ITU em UTI, uma vez que a doença pode ser fatal se uma terapia não for instituída, portanto, nós aconselhamos avaliações mais minuciosas, tanto da racionalidade do uso de antibióticos, quanto dos fatores de risco para o desenvolvimento de ITUs em UTIs.Research, Society and Development2021-03-21info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://rsdjournal.org/index.php/rsd/article/view/1351610.33448/rsd-v10i3.13516Research, Society and Development; Vol. 10 No. 3; e43910313516Research, Society and Development; Vol. 10 Núm. 3; e43910313516Research, Society and Development; v. 10 n. 3; e439103135162525-3409reponame:Research, Society and Developmentinstname:Universidade Federal de Itajubá (UNIFEI)instacron:UNIFEIporhttps://rsdjournal.org/index.php/rsd/article/view/13516/12158Copyright (c) 2021 Lucas Harassim; Olibio Lopes Fiebig da Silva; Luiz Felipe Soares Pinheiro; Elber José Assaiante dos Santos; Cláudio Daniel Cerdeira; Gérsika Bittencourt Santos Barroshttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessHarassim, Lucas Silva, Olibio Lopes Fiebig da Pinheiro, Luiz Felipe Soares Santos, Elber José Assaiante dos Cerdeira, Cláudio DanielBarros, Gérsika Bittencourt Santos 2021-03-28T12:03:35Zoai:ojs.pkp.sfu.ca:article/13516Revistahttps://rsdjournal.org/index.php/rsd/indexPUBhttps://rsdjournal.org/index.php/rsd/oairsd.articles@gmail.com2525-34092525-3409opendoar:2024-01-17T09:34:50.384528Research, Society and Development - Universidade Federal de Itajubá (UNIFEI)false |
dc.title.none.fl_str_mv |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit Factores de riesgo y perfil del uso de antimicrobianos en pacientes con infección del tracto urinario en una unidad de cuidados intensivos Fatores de risco e perfil do uso de antimicrobianos entre pacientes com infecção no trato urinário em uma unidade de terapia intensiva |
title |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
spellingShingle |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit Harassim, Lucas Infecção no Trato Urinário Unidade de Terapia Intensiva Antibiótico Escherichia coli ITU UTI Acinetobacter baumannii. Infección del tracto urinario Unidad de cuidados intensivos Antibiótico Escherichia coli Acinetobacter baumannii. Urinary tract infections Intensive Care Units Antimicrobial Escherichia coli UTI ICU Acinetobacter baumannii. |
title_short |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
title_full |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
title_fullStr |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
title_full_unstemmed |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
title_sort |
Risk factors and profile of antimicrobial use among patients with urinary tract infection at an intensive care unit |
author |
Harassim, Lucas |
author_facet |
Harassim, Lucas Silva, Olibio Lopes Fiebig da Pinheiro, Luiz Felipe Soares Santos, Elber José Assaiante dos Cerdeira, Cláudio Daniel Barros, Gérsika Bittencourt Santos |
author_role |
author |
author2 |
Silva, Olibio Lopes Fiebig da Pinheiro, Luiz Felipe Soares Santos, Elber José Assaiante dos Cerdeira, Cláudio Daniel Barros, Gérsika Bittencourt Santos |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Harassim, Lucas Silva, Olibio Lopes Fiebig da Pinheiro, Luiz Felipe Soares Santos, Elber José Assaiante dos Cerdeira, Cláudio Daniel Barros, Gérsika Bittencourt Santos |
dc.subject.por.fl_str_mv |
Infecção no Trato Urinário Unidade de Terapia Intensiva Antibiótico Escherichia coli ITU UTI Acinetobacter baumannii. Infección del tracto urinario Unidad de cuidados intensivos Antibiótico Escherichia coli Acinetobacter baumannii. Urinary tract infections Intensive Care Units Antimicrobial Escherichia coli UTI ICU Acinetobacter baumannii. |
topic |
Infecção no Trato Urinário Unidade de Terapia Intensiva Antibiótico Escherichia coli ITU UTI Acinetobacter baumannii. Infección del tracto urinario Unidad de cuidados intensivos Antibiótico Escherichia coli Acinetobacter baumannii. Urinary tract infections Intensive Care Units Antimicrobial Escherichia coli UTI ICU Acinetobacter baumannii. |
description |
Urinary Tract Infections (UTI) affecting patients at Intensive Care Units (ICU) is a preoccupant reality, further aggravated by inadequate antimicrobial use and the alarming antimicrobial resistance in microorganisms. We evaluated the level of assertiveness regarding the use of antimicrobials during the empirical antibiotic-therapy (EA), in patients with UTI, comparing the empiric pharmacological treatments (EA) and those ones performed after the antibiogram (guided therapy). Moreover, we estimated the prevalence of the causative agents and analyzed the risk factors associated. This is an observational and cross-sectional study, undertaken in 2015, in which patients (both gender and all ages) with UTI and underwent antimicrobial therapy, enrolled at an ICU in a hospital in the southern region of the Brazilian state of Minas Gerais, Brazil, were evaluated. Among the 49 patients evaluated (28 females [F] and 21 males [M]), the mean age was 55±19 years (CI(95) 49-61) and the predominant age range was ≥70 years. Fourteen different microorganisms were identified. 28.3% (CI(95%) 16.2-40.4) of the UTI had Escherichia coli as causative agent (33.3% M and 28.6% F); 18.9% (CI(95%) 8.3-29.4) Acinetobacter baumannii (33.3% M and 10.7% F); 15.1% (CI(95%) 5.5-24.7) Klebsiella pneumoniae (19% M and 14.3% F); 11.3% Pseudomonas aeruginosa (9.5% M and 14.3% F); 5.7% Enterobacter aerogenes (14.3% M); 3.8% Klebsiella oxytoca; 3.8% Staphylococcus aureus (7.1% F); and 2% for each of the microorganisms as follows: Enterococcus faecalis (4.8% M); Proteus mirabilis (3.6% F); Enterobacter cloacae (3.6% F); Providencia rettgeri (4.8% M); Citrobacter koseri (3.6% F); Citrobacter freundii (3.6% F); and Yeasts (4.8% M). The prevalence of UTI caused by A. baumannii and P. aeruginosa in the ITUs were influenced by the patients’ sex (χ² with p<0.001). In the male sex, it there was “substantial” positive correlations between the most increased ages (in years) and the prevalence of UTI caused by E. coli (r = 0.69) or between the decreased ages and the prevalence of UTI caused by A. baumannii (r = -0.7). In the female sex, it there was an “extremely” positive correlation between the most increased ages and the prevalence of UTI caused by E. coli (r = 0.94; CI(95) 0.66-0.99; p<0.0014). The most used antimicrobials in an empirical fashion (EA) were: Ciprofloxacin (14.3% CI(95%) 4.7-24.1), Cefepime (14.3%), and Vancomicin (10%); and after antibiogram (guided therapy): Ceftazidime (16.3% CI(95%) 6-26.7), Ciprofloxacin (14.3% CI(95%) 4.5-24.1), Polymyxin B (10.2%), Imipenem (10.2%), and Ampicillin/sulbactam (8.2%). In 20% of cases, the EAs were considered “inappropriate/not correct”. However, we must also be aware of the clinical need and the immediacy for the treatment of UTIs in an ICU, since the disease can be fatal if a therapy is not instituted, therefore, we advise more detailed assessments, both of the rationality of use antibiotics, as well as the risk factors for the development of UTIs in ICUs. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-03-21 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://rsdjournal.org/index.php/rsd/article/view/13516 10.33448/rsd-v10i3.13516 |
url |
https://rsdjournal.org/index.php/rsd/article/view/13516 |
identifier_str_mv |
10.33448/rsd-v10i3.13516 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://rsdjournal.org/index.php/rsd/article/view/13516/12158 |
dc.rights.driver.fl_str_mv |
https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Research, Society and Development |
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Research, Society and Development |
dc.source.none.fl_str_mv |
Research, Society and Development; Vol. 10 No. 3; e43910313516 Research, Society and Development; Vol. 10 Núm. 3; e43910313516 Research, Society and Development; v. 10 n. 3; e43910313516 2525-3409 reponame:Research, Society and Development instname:Universidade Federal de Itajubá (UNIFEI) instacron:UNIFEI |
instname_str |
Universidade Federal de Itajubá (UNIFEI) |
instacron_str |
UNIFEI |
institution |
UNIFEI |
reponame_str |
Research, Society and Development |
collection |
Research, Society and Development |
repository.name.fl_str_mv |
Research, Society and Development - Universidade Federal de Itajubá (UNIFEI) |
repository.mail.fl_str_mv |
rsd.articles@gmail.com |
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1797052817398038528 |