Aspectos epidemiológicos de infecções da corrente sanguinea e fatores de risco associados ao óbito em pacientes internados no hospital do câncer, Rio de Janeiro

RESUMO

A infecção da corrente sanguinea (ICS) é uma das causas de morbidade e mortalidade em pacientes com câncer. Durante um período de 24 meses, 349 pacientes internados no Hospital do Cãncer do Rio de Janeiro, Brasil, desenvolveram 435 episódios de ICS (3,5 episódios/100pacientes-dia). As infecções nosocomiais foram responsáveis por 68,3 (por cento) das ICS, e entre estas infecções predominaram os pacientes com idade inferior a 40 anos e não-neutropênicos. Em 74,9(por cento) dos casos as infecções foram unimicrobianas. A origem foi desconhecida em 52,8 (por cento). Os principais agentes etiológicos foram os estafilococos 31,8 (por cento) e a terapia antimicrobiana inicial foi adequada em 60,5 ( por cento) dos episódios.

ABSTRACT

Bloodstream infection (BSI) is one of the main causes of morbidity and mortality in cancer patients. During a 24-month study, there were 435 episodes of BSIs in 349 patients (3,5 episodes/1000 patients-day) admitted to the Hospital do Cancer in Rio de Janeiro, Brazil. Nosocomial infections were responsible for 68,3% of the BSI and non-neutropenic patients below 40-years of age predominated. The unimicrobial infections were responsible for 74.9% of cases. In 52,8% the origin could not be determined. The main etiologic pathogens were staphylococci (31.8%). The initial antimicrobial therapy was adequate in 60,5% of cases. Multivariate analysis identified the central venous catheter [odds ratio (OR) 6.71], poor performance status (OR 3.40), weight loss (OR 2.47), hematologic diseases (OR 2.24), and previous antimicrobial therapy (OR 2.12) as independent factors for BSIs in adults. The independent variables for BSl associated with death, identified by multivariate analysis, were poor performance status (RR 4.71), hypotension (RR 2.88), weight loss (RR 2.66) and absence of fever (RR 2.37). Mortality rate atributable to the BSls was 21.9%. The study allowed the identification of modifiable risk factors for BSls and implementations concerning morbidity and mortality reduction.