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BMC Infect Dis ; 16: 274, 2016 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-27286681

RESUMO

BACKGROUND: Cancer patients have a higher risk of severe sepsis in comparison with non-cancer patients, with an increased risk for hospital-acquired infections (HAI), particularly with multidrug resistant bacteria (MDRB). The aim of the study is to describe the frequency and characteristics of HAI and MDRB in critically ill cancer patients. METHODS: We conducted an 18-month prospective study in patients admitted ≥48 h to an ICU at a cancer referral center in Mexico. Patients with hematological malignancies (HM) were compared with solid tumors. Demographic and clinical data were recorded. Mortality was evaluated at 30-days. RESULTS: There were 351 admissions during the study period, among whom 157 (66 %) met the inclusion criteria of the study as follows: 104 patients with solid tumors and 53 with HM. Sixty-four patients (40.7 %) developed 95 episodes of HAI. HAI rate was 4.6/100 patients-days. MDRB were isolated in 38 patients (24 %), with no differences between both groups. Escherichia coli was the main bacteria isolated (n = 24), 78 % were extended spectrum beta-lactamases producers. The only risk factor associated with HAI was the presence of mechanical ventilation for more than 5 days (OR 3.12, 95 % CI 1.6 - 6.2, p = 0.001). At 30-day follow-up, 61 patients (39 %) have died (38 % with solid tumors and 60 % with HM, p < 0.001). No differences were found in mortality at 30-day between patients with HAI (n = 25, 39 %) vs. non-HAI (n = 36, 38.7 %, p = 0.964); neither in those who developed a HAI with MDRB (n = 12, 35.3 %) vs. HAI with non-MDRB (n = 13, 43.3 %, p = 0.51). CONCLUSIONS: Patients with cancer who are admitted to an ICU, have a high risk of HAI, but there were no differences patients with solid or hematologic malignancies.


Assuntos
Infecção Hospitalar/epidemiologia , Neoplasias Hematológicas/epidemiologia , Unidades de Terapia Intensiva , Serviço Hospitalar de Oncologia , Sepse/epidemiologia , Acinetobacter , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Cuidados Críticos , Estado Terminal , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Enterococcus faecium/isolamento & purificação , Enterococcus faecium/fisiologia , Escherichia coli/isolamento & purificação , Escherichia coli/fisiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Klebsiella/isolamento & purificação , Klebsiella/fisiologia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Pancitopenia/epidemiologia , Estudos Prospectivos , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Sepse/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Enterococos Resistentes à Vancomicina
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