Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis

Abstract Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings.

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Abstract: INTRODUCTION: The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. METHODS Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-β-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. RESULTS: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. CONCLUSIONS This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.

Dengue: Prevenção, Controle eCuidados de Enfermagem - Revisão Integrativa da Literatura 2008-2013 / Dengue: Prevention, Control and Nursing Care – An Integrative Review of the Literature 2008-2013

O objetivo foi realizar uma revisão integrativa daliteratura, relacionada à prevenção e controle da Dengue eos cuidados de enfermagem prestados aos pacientesinfectados pelo vírus da dengue. Material e Métodos: O estudodesenvolvido foi qualitativo-descritivo, e utilizou-se de revisãointegrativa da literatura nacional e internacional, cujos dadosforam coletados da Biblioteca Virtual em Saúde das basesde dados SCIELO, LILACS, PUBMED a partir dos descritorescombinados: “Dengue e Prevenção e Cuidados deEnfermagem’’ no período de 2008 a 2013. Resultados: Abusca originou 134 artigos, após sucessivas leituras eeliminação das duplicidades, obteve-se como amostra finalum total de 14 artigos. Os dados mostram que a prevençãoda dengue constitui atividade essencial na redução do númerode casos quando adequadamente desenvolvida, contribuindopara a redução do número de ocorrências graves da doença.O controle através do combate ao vetor em suas formas dedesenvolvimento e vigilância epidemiológica intensiva sobreos possíveis focos da doença é vital. Os cuidados deenfermagem são focados em estabelecer diagnósticos,intervenções, predizer e avaliar resultados, em sumabuscando reestabelecer a saúde do paciente infectado pelovírus da dengue. Conclusão: A revisão integrativa deliteratura mostrou que a eficiência nas medidas de prevençãoe no controle são primordiais para redução do número decasos da doença, juntamente com isso, os cuidados deenfermagem são essenciais para o reestabelecimento dasaúde dos pacientes, através do diagnóstico, intervençõese avaliação dos resultados...

To perform an integrative literature review aboutprevention and control of dengue fever and about the nursingcare currently offered to patients infected by the virus.Material and Methods: This is a qualitative, descriptiveliterature review of national and international publications.The articles were extracted from the following virtualdatabases: Brazilian Health Virtual Library (BVSMS), SCIELO,LILACS, and PUBMED, using the descriptors “Dengue fever”,“Prevention”, and “Nursing Care”. The selected articles werepublished between the year 2008 and 2013. Results: Thefirst search resulted in 134 articles. After multiple readingsand elimination of duplicity, 14 articles were included in thefinal sample. The data showed that properly developedprevention is essential to achieve reduction in the number ofdengue fever cases, ultimately helping to decrease theoccurrence of acute forms of the disease. The control throughcombating the vector in its multiple stages of developmentand intensive epidemiologic vigilance over possible outbreaksites, are vital. Nursing care is focused on establishingdiagnosis, interventions, predicting and evaluating outcomes,overall aiming to reestablish the health of patients infectedby the dengue virus. Conclusion: This integrative literaturereview shows that efficiency in disease prevention andcontrol are vital to decrease the number of dengue fevercases. Along with that, nursing care is essential for thereestablishment of the patient’s health as a result of diagnosis,interventions, and evaluation of outcomes...

Prevalência de agentes microbianos e sensibilidade da Pseudomonas aeruginosa / Prevalence of microbial agents and sensitivity Pseudomonas aeruginosa

Objetivo: descrever a ocorrência de agentes microbianos e avaliar o perfil de sensibilidade de Pseudomonas aeruginosa provenientes de pacientes internados em Unidade de Terapia Intensiva UTI de hospital sentinela em Belém, Pará no período de 2005 a 2010. Método: abordagem retrospectiva e quantitativo-descritiva com dados oriundos da consulta das fichas dos pacientes, dos arquivos da comissão de controle de infecção hospitalar. Resultados: dentre os micro-organismos isolados obteve-se 40,8% de Staphylococus coagulase negativo, 11,4% de P. aeruginosa e 7,4% de Staphylococcus aureus. A ocorrência de infecções por P. aeruginosa foi maio na UTI adulto. A infecção respiratória foi predominante na UTI adulto e a infecção de corrente sanguínea predominante nas UTI pediátrica e neonatal. Conclusões: foram encontrados 49 grupos de micro-organismos na população estudada, sendo o Staphylococcus sp coagulase negativo, P. aeruginosa, S. aureus, Candida albicans, Acinetobacter baumanni e Klebsiella pneumoniae os mais predominantes. A P. aeruginosa apresentou elevada resistência aos antibióticos tradicionais. Os resultados obtidos neste trabalho destacam a importância de estudos epidemiológicos contínuos com a finalidade de se evitar a instalação de surtos.

Objective: to describe the occurrence of microbial agents and evaluate the sensitivity of Pseudomonas aeruginosa from patients hospitalized en the Intensive Care Unit (ICU) of sentinel hospital in Belém (Pará), on the period 2005-2010. Methods: retrospective and quantitative approach - with descriptive data from the query of patient records, the files of the hospital infection control committee. Results: among the isolated microorganisms got 40,8% of coagulase-negative staphylococci, 11,4% of P. aeruginosa 7,4% of Staphylococcus aureus. The occurrence of P. aeruginosa infections was higher in the adult ICU. The respiratory infection was predominant in the adult ICU and bloodstream infection prevalent in pediatric and neonatal ICU. Conclusions: 49 groups of microorganisms were found in the population studied, coagulase negative Staphylococcus spp, P. aeruginosa, S. aureus, Candida albicans, A. baumannii and Klebsiella pneumoniae the most prevalent. P. aeruginosa was highly resistant to traditional antibiotics. The results of this study highlight the importance of ongoing epidemiological studies in order to avoid the installation of outbreaks.