Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade
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2014-07-08
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Universidade Federal de Goiás
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Stenotrophomonas maltophilia is a Gram-negative bacillus found in natural and in hospital environments. S maltophilia’s high level intrinsic resistence to antibiotics and heavy metals justifies the importance of this bacteria in the nosocomial environment. The aim of this study was to describe the clinical and epidemiological characteristics, and the outcome of infection due to S. maltophilia; describe the antibiotic sensitivity and the genetic relatedness from this bacteria from january 2010 to july 2013 in Hospital das Clínicas – UFG (HC/UFG). Clinical and epidemiological data were obtained from medical records of patients; antimicrobial sensitivity was determined by the methodology Vitek 2®; and the genetic similarity was determined by Pulsed-Field Gel Eletrophoresis (PFGE). Over the study period, 75 isolates of S. maltophilia were indentified in 56 patients, with mean of 1.34 isolates per patient (range 1-8). Among the total, 34.6% were in the clinical intensive care unit, and 17.3% in the clinical infirmary. The 3 intensive care unit accounted for 56% of all isolates. The mean age of patientes was 45.75 years (range 0-83 years), and 51.8% were male. All cases of infection were considered health care-associated. The most comom coexisting condition were haematological malignancy, in 18 (32.1%) patientes. The most frequent clinical manifestations was fever in 47 (83.9%) patients, and leukocytosis or leukopenia in 31 (55.4%). Invasive devices were frequently used, and central venous cateter, and mechanical ventilation were the most. Most patients (94.6%) used broad spectrum antibiotics before the acquisition of the bacteria. The most frequent type of infection was ventilator-associated pneumonia (42.9%) followed by cateter-associated bacteremia (16.1%). Trimethoprim-sulfamethoxazole was the treatment of choice in 32 (57.1%) patients. The outcome of infection due to S. maltophilia was infection-related death in 62.5%. The risk factors related to mortality in this study were shock, acute renal failure, use of mechanical ventilation, use of urinary device and feeding tube. Trimethoprim-sulfamethoxazole resistance, the treatment of choice for infection by S. maltophilia, and levofloxacin resistence were detected in HC / UFG. Twenty isolates were assessed for genetic variability by pulsed-field gel eletrophoresis (PFGE) with observation of high variability between strains. We conclude that S. maltophilia is a nosocomial bacteria of clinical importance mainly due to high associated mortality, and few therapeutic options. Resistance to trimethoprim/sulfamethoxazole was low, but must be monitored in HC / UFG.
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SILVA, C. N. G. N. Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade. 2014. 103 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2014.