Fatores de risco e evolução clinica em pacientes com infecção de corrente sanguínea por Enterococcus spp resistente a vancomicina em um hospital universitário em São Paulo

Autor: Furtado, Guilherme Henrique Campos [UNIFESP]
Jazyk: portugalština
Rok vydání: 2005
Předmět:
Zdroj: Repositório Institucional da UNIFESPUniversidade Federal de São PauloUNIFESP.
Druh dokumentu: masterThesis
Popis: Made available in DSpace on 2015-12-06T23:05:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2005
0 enterococo resistente à vancomicina( VRE) é hoje patógeno de imensa importância no ambiente hospitalar, com aumento progressivo em sua incidência como causador de infecções nosocomiais. A bacteremia é uma das principais infecções causadas por este 1 patógeno e devido a sua importância e limitados dados nacionais foi definida como objeto deste estudo. Foram realizados dois estudos procurando avaliar a epidemiologia desta infecção em um hospital universitário. 0 primeiro estudo teve como objetivo avaliar os fatores de risco para bacteremia por VRE. No período de janeiro de 2001 a dezembro de 2003 foram estudados 34 pacientes com bacteremia por VRE, que foram comparados com 102 pacientes-controle pareados por ~ unidade de internação, sexo e idade. Tivemos durante o estudo uma incidência média de infecção de corrente sangüínea por VRE de 0,18 por 1000 pacientes-dia e de 0,11 por 100 saídas. A análise dos resultados demonstrou os seguintes fatores de risco estatisticamente significantes na análise univariada : uso de carbapenem( p= 0,003), uso de cefalosporinas p=0,017), uso de macrolídeos ( p= 0,025), uso de polimixina B( p= 0,004), uso de vancomicina( p< 0,001), uso de cateter venoso central ( p= 0,023), uso de ventilação mecânica( p= 0,021), uso de sonda nasogástrica/nasoenteral( p= 0,001), tempo de internação( p< 0,001) e número de antibióticos(p= 0,001). Na análise multivariada, o único fator de risco independentemente associado à bacteremia por VRE foi : o uso prévio de vancomicina( OR= 10,19; IC9so¿= 3,63- 28,57)¿(au)
Vancomycin-resistant Enterococcus( VRE) is currently a very important pathogen at hospital environment, with progressive increase on its incidence as a cause of nosocomial infections. Bacteremia is a leading infection caused by this pathogen and due its importance and restricted national data was defined as objective of this study. Two studies were performed in order to evaluate the epidemiology of this type of infection at an university-affiliated hospital. The first study evaluated the risk factors for bacteremia by VRE. During the period from january 2001 to december 2003 we studied 34 patients with bacteremia by VRE who were compared to 102 control-patients matched by admission unit, sex and age. We had a average incidence of bloodstream infection by VRE of 0.18 per 1000 patient-days and 0.11 per 100 discharges. The analysis of the results, showed that the following risk factors were statistically significant in univariate analysis: carbapenem use( p= 0,003), cephalosporin use( p= 0,017), macrolides use( p=0,025), polimyxyn use(p= 0,004), vancomycin use( p < 0,001), central venous catheter use( p= 0,023), mechanic ventilation use( p=0,021), nasogastric/nasoenteral tube use( p=0,001), lenght of hospital stay( p< 0,001) and number of antibiotics( p= 0,001). The only factor independently associated to bacteremia on multivariate analysis was : previous vancomycin use( OR= 10,19 ; IC95%= 3,63- 28,57). 113 The second study was performed with the aim to study comparatively the patients with bacteremia by VRE and VSE in order to define differences between the groups concerning clinical outcome. We studied 34 patients with VRE bacteremia and 55 patients with VSE bacteremia admitted in several hospital units. The analysis of results showed that the following factors were statistically significant on univariate analysis: previous carbapenem use( p= 0,001), previous vancomycin use( p< 0,001), mechanical ventilation( p=0,016), nasogastric/nasoenteral tube use( p= 0,004), vasoactive drug use( p= 0,013), lenght of hospital stay( p< 0,001), number of antibiotics( p= 0,001). The only factors statistically significants on multivariate analysis between the two groups were: vasoactive drug use ( OR= 3,61; CI95%= 1,02- 12,72) and number of antibiotics( OR= 1,57; CI95%= 1,15-2,15) in first model and vasoactive drug use( OR= 5,68; CI95%= 1,25- 25,89) and previous vancomycin use( OR= 17,58; CI95%= 5,24-58,96) in second model. The most common Enterococcus species that caused bloodstream infection in our study was E.faecalis( 100% in VRE group and 95,6% in VSE group). There was 100% of sensivity to ampicillin, streptomycin and linezolide in VRE group. Due the importance of VRE bacteremia in hospitals, it is crucial to define the main risk factors associated to it and to observe whether there is differences on outcome in enterococcal bacteremia concerning vancomycin resistance.
BV UNIFESP: Teses e dissertações
Databáze: Networked Digital Library of Theses & Dissertations
Externí odkaz: