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Device-associated infection rates in intensive care units of Brazilian hospitals: datos de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales / Tasa de infecciones asociadas a aparatos en unidades de cuidados intensivos de hospitales brasileños: datos de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales
Salomao, Reinaldo; Rosenthal, Victor D; Grimberg, Gorki; Nouer, Simone; Blecher, Sergio; Buchner-Ferreira, Silvia; Vianna, Rosa; Maretti-da-Silva, Maria Ângela.
  • Salomao, Reinaldo; Santa Marcelina Hospital. Division of Infection Control. São Paulo. BR
  • Rosenthal, Victor D; Medical College of Buenos Aires. Department of Infection Control. Buenos Aires. AR
  • Grimberg, Gorki; Porto Alegre General Hospital. Division of Infection Control. Porto Alegre. BR
  • Nouer, Simone; Clementino Fraga Filho University Hospital. Division of Infection Control. Rio de Janeiro. BR
  • Blecher, Sergio; Santa Marcelina Hospital. Division of Infection Control. São Paulo. BR
  • Buchner-Ferreira, Silvia; Medical College of Buenos Aires. Department of Infection Control. Buenos Aires. AR
  • Vianna, Rosa; Clementino Fraga Filho University Hospital. Division of Infection Control. Rio de Janeiro. BR
  • Maretti-da-Silva, Maria Ângela; Santa Marcelina Hospital. Division of Infection Control. São Paulo. BR
Rev. panam. salud pública ; 24(3): 195-202, sept. 2008. tab
Article in English | LILACS | ID: lil-495418
ABSTRACT

OBJECTIVES:

To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC).

METHODS:

Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS).

RESULTS:

Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8 percent or 29.8 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7 percent of cases, resistant to ceftazidime in 79.3 percent of cases, and resistant to piperacillin-tazobactam in 85.7 percent of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3 percent of cases, resistant to ceftazidime in 75.5 percent of cases, and resistant to imipenem in 27.7 percent of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3 percent (RR 1.79, P = 0.0149) for VAP, 27.8 percent (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7 percent (RR 1.56, P = 0.2875) for CAUTI.

CONCLUSION:

The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an ...
RESUMEN

OBJETIVOS:

Determinar las tasas de infección asociadas a aparatos (IAA), los perfiles microbiológicos, la resistencia bacteriana, la estancia hospitalaria adicional y la mortalidad atribuible en las unidades de cuidados intensivos (UCI) de tres hospitales brasileños miembros de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales (INICC).

MÉTODOS:

Se realizó una vigilancia prospectiva de cohorte de las IAA en cinco UCI de tres hospitales urbanos de Brasil, según las definiciones del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) de los Estados Unidos de América.

RESULTADOS:

Entre abril de 2003 y febrero de 2006 se hospitalizaron 1 031 pacientes en las cinco UCI estudiadas, con un total de 10 293 días en los que se adquirieron 307 IAA, para una tasa de 29,8 por ciento (29,8 IAA por 1 000 días-UCI). Las tasas fueron de 20,9 casos por 1 000 días-ventilador en neumonía asociada a respiradores (NAR); de 9,1 por 1 000 días-catéter en infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC); y de 9,6 por 1 000 días-catéter en infecciones urinarias asociadas con el uso de catéteres (IUAC). De las IAA causadas por Staphylococcus aureus, 95 por ciento se debieron a cepas resistentes a la meticilina. De las infecciones causadas por Enterobacteriaceae, 96,7 por ciento fueron resistentes a la ceftriaxona, 79,3 por ciento a la ceftazidima y 85,7 por ciento a la combinación piperacilina-tazobactam. De las IAA causadas por Pseudomonas aeruginosa, 71,3 por ciento resultaron resistentes a la ciprofloxacina, 75,5 por ciento a la ceftazidima y 27,7 por ciento al imipenem. Los pacientes con IAA en las UCI estudiadas presentaron tasas de mortalidad adicional de 15,3 por ciento (riesgo relativo [RR] = 1,79; P = 0,0149) por NAR, 27,8 por ciento (RR = 2,44; P = 0,0004) por IC-CVC y 10,7 por ciento (RR = 1,56; P = 0,2875) por IUAC. ...
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Catheters, Indwelling / Cross Infection / Infection Control / Surgical Fixation Devices / Hospitals / Intensive Care Units / International Cooperation Type of study: Risk factors Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. panam. salud pública Journal subject: Public Health Year: 2008 Type: Article Affiliation country: Argentina / Brazil Institution/Affiliation country: Clementino Fraga Filho University Hospital/BR / Medical College of Buenos Aires/AR / Porto Alegre General Hospital/BR / Santa Marcelina Hospital/BR

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Full text: Available Index: LILACS (Americas) Main subject: Catheters, Indwelling / Cross Infection / Infection Control / Surgical Fixation Devices / Hospitals / Intensive Care Units / International Cooperation Type of study: Risk factors Limits: Humans Country/Region as subject: South America / Brazil Language: English Journal: Rev. panam. salud pública Journal subject: Public Health Year: 2008 Type: Article Affiliation country: Argentina / Brazil Institution/Affiliation country: Clementino Fraga Filho University Hospital/BR / Medical College of Buenos Aires/AR / Porto Alegre General Hospital/BR / Santa Marcelina Hospital/BR