Infecções por Acinetobacter baumannii em adultos admitidos em unidades de terapia intensiva (UTIs) de Goiânia e Aparecida de Goiânia
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2012-03-23
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Universidade Federal de Goiás
Resumo
Acinetobacter baumannii (Ab), has an important role in healthcare-associated
infections, present a rapid global and emerging multidrug-resistant (MDR) strains, affecting
many countries. In Brazil, Ab is responsible for outbreaks infections in intensive care units
(ICUs) since 1996, with high rates of antimicrobial resistance. This was a descriptive cohort
study of adult infected with Ab during the period of June to December of 2010, that evaluated
the clinical and epidemiological profile of infections caused by Ab and analyzed genetically,
by pulsed field gel electrophoresis (PFGE), clinical isolates from patients admitted in five
ICUs of the Municipality of Goiania. We identified 64 cases of patient infected or colonized
with Ab during the study period, 84 samples culture positive for Ab with a global infection
rate of 4.8%. Infection incidence at each hospital was as follows: 10 % in ICU-1, 4.3% in
ICU-2, 7.8% in ICU-3, 1.3% in ICU-4, and 7.5 % in ICU-5. The mean age of patients was
53.2 years (sd=19) and 59.4% (38) were male. Symptomatic infections occurred in 90.6% of
the cases. The most frequent site of infection was pulmonary (53.1%), followed by surgical
site (10.9%), and urinary tract (7.8%). The most common underlying diseases were neoplasia
(34.4%) and AIDS (17.2%). Most of the patients infected with Ab (98.4%) had received
antimicrobial therapy previously. The most frequently used drugs were cephalosporins
(71.4%), carbapenems (50.8%), glycopeptides (46.0%), and fluoroquinolones (33.3%).
Among the invasive procedures realized prior to Ab infection, intravascular catheters and
vesical catheters where the most frequent (93.7%). The culture results from the isolate of each
patient revealed that carbapenems resistance was 73.4%, ampicillin-sulbactam 60.9%,
amikacin 20.3%, polymyxins 6.2%, tigecycline 3.1%. The overall mortality rate was 79.7%
and related mortality rate to Ab infection was 67.2%. PFGE analysis of the isolates from 56
patients demonstrated the dissemination of genetically related clones within the ICU and
between the different ICUs, and the identification of a major outbreak of MDR Ab in four out
of the five analyzed ICUs involving 12 patients. In conclusion a high rate of antimicrobial
resistance was detected as well as a high mortality rate among ICU patients infected with Ab,
requiring stronger and more efficient measures to control this agent, as well as urgent
measures are needed for the rational utilization of antibiotics in ICUs.
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GODOY, Cássia Silva de Miranda. Infecções por Acinetobacter baumannii em adultos admitidos em unidades de terapia intensiva (UTIs) de Goiânia e Aparecida de Goiânia. 2012. 84 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2012.