Fatores de risco para colonização e sepse por Candida albicanse Candida não albicans em neonatos críticos / Risk factors for colonization and sepsis by Candida albicans and non-albicans Candida in critical newborns

O objetivo do estudo foi avaliar as taxas de sepse e de colonização por Candida albicans e Candida não albicans e os fatores de risco relacionados em neonatos críticos. O estudo foi realizado na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital de Clínicas da Universidade Federal de Uberlândia, com 10 leitos, através de dois tipos de vigilância epidemiológica: “National Nosocomial Infections Surveillance”(NNIS) e laboratorial, no período de Jan/02 a Dez/07. As amostras de Candida isoladas de infecção foram obtidas no Laboratório de Microbiologia do hospital. Os neonatos foram avaliados quanto à colonização nas mucosas oral e intestinal, após 24 horas da internação na unidade e em intervalos semanais até a alta, utilizando-se “swab” estéril, cultivado em “Cromo-agar”. No total, a taxa de sepse foi 13,6%, sendo que as candidemias responderam por 6% das mesmas, todas de natureza hospitalar, associadas com uma letalidade de 33,3%. A taxa de infecção por Candida/ 1.000 pacientes dia foi de 0,96, sendo a maioria (47,4%; 9/19) por Candida albicans. Foram constatados 19 (54,28%) neonatos colonizados, dos quais originaram 35 amostras, 15 de mucosa bucal com 53,3% por Candida albicans e 46,7% Candida não albicans, e 20 de mucosa perianal com 50,0% por Candida albicans. Os fatores de risco associados com a candidemia invasiva (P d” 0,05) foram: uso de CVC e de antibióticos, e para colonização por Candida foram: nutrição parenteral, entubação e uso prévio de antibiótico com um predomínio de cefalosporina de terceira geração (83,3%). Não foi observada relação entre colonização prévia e candidemia invasiva, com o de apenas uma criança com sepse por Candida albicans, colonizada previamente.

The objective of this study was to evaluate the rates of sepsis and colonization by Candida albicans andnon- albicans Candida and the risk factors observed in critical newborns. The study was carried out in a 10-bed Neonatal Intensive Care Unit (NICUs) of the Clinical Hospital of the Federal University of Uberlândia, through two types of epidemiological surveillance: “National Nosocomial Infections Surveillance" (NNIS) and laboratorial in the period of Jan/02 to Dec/07. Samples of Candida isolated from infection were obtained in the Laboratory of Microbiology of the hospital. The newborns were evaluated according to oral and intestinal colonization, after 24 hours of hospitalization in that unit in weekly intervals until discharge. Overall, the rate of sepsis was 13.6%, and the candidemias accounted for 6%, from hospital nature , associated with 33.3% of lethality. The rate of infection by Candida/1,000 patient daily was 0.96, while the majority (47.4%; 9/19) by Candida albicans. Nineteen (54.28%) neonates colonized were observed from them 35 samples were provided, 15 of oral mucosa with 53.3% by Candida albicans, and 46.7% by non-albicans Candida, and 20 of mucous perianal with 50.0% by Candida albicans. The risk factors associated with invasive candidemia (P d” 0.05) were: use of CVC and antibiotics, and colonization by Candida were: parenteral nutrition, intubation and previous use of antibiotic with a predominance of the third generation cephalosporin ( 83.3%). There was no relationship between prior colonization and invasive candidemia, with only one child with sepsis by Candida albicans, previously colonized.

Two outbreaks of mixed etiology associated with central venous catheters inserted by phlebotomy in critical neonates

Staphylococcus aureus and coagulase-negative staphylococci are the main cause of sepsis in Neonatal Intensive Care Unit (NICU). Central venous catheters (CVCs) are an important part of critical neonates' treatment and are associated with sepsis. The aim of this study was to investigate two outbreaks caused by Staphylococcus aureus and Staphylococcus epidermidis associated with CVC inserted by phlebotomy in critical neonates. The surveillance was performed from January 2001 to December 2005 at the Brazilian NICU. The genotypic analysis of oxacillin susceptible S. aureus (OSSA) and oxacillin resistant S. epidermidis (ORSE) was performed based on pulsed-field gel electrophoresis (PFGE). Staphylococcus was the most frequent pathogen (65.8 percent) with highest incidence of CoNS (59.9 percent) followed by S. aureus (40.1 percent). During the five years of surveillance, there were two outbreaks detected, occurred in January-February/02 and August/02 and confirmed by PFGE analysis. The predisposing factors for infection corresponding to both outbreaks were: age <7 days, hospitalization > 7 days, and use of polyethylene CVC through dissection of vein (phlebotomy). This is the first relate of staphylococcal outbreaks associated with CVC inserted by phlebotomy in NICU. PFGE showed polyclonal spread of OSSA during both epidemic and endemic period, and two monoclonal outbreaks of ORSE in the same epidemic period of OSSA.