Monitorização de pacientes para microrganismos resistentes em uma unidade de terapia intensiva: uma análise da incidência e dos fatores associados

Abstract

The health care associated infections (HAIs) caused by resistant microorganisms (MR) represent a major public health problem, because of increased morbidity and mortality, increase in length of stay associated costs, mainly for being considered the possibility of prevention. Infection and colonization by resistant bacteria or stand out in Intensive Care Units (ICU). The routine use of tools that facilitate monitoring of MR patients is still limited and should integrate essential mechanisms in controlling the spread of these in clinical practice. Given this, aimed to monitor patients in a intensive care unit through admission to surveillance cultures and during hospitalization for colonization by resistant microorganisms. This is an epidemiological study of prospective cohort performed in an ICU, in Minas Gerais. Were followed all patients admitted to the ICU from May to August 2014. These were included in the admission to surveillance culture protocol and during the time spent in the unit. Was carried out monitoring of patients with cultures through nasal swabs, axillary and groin during the hospital stay until discharge or death. 64 patients were followed during the study period and conducted 252 surveillance cultures, of which 28/252 (11.1%) positive cultures located in the groin, 20/252 (7.9%) in the nasal region and 10/252 (3.9%) in the armpit. These were observed 41/64 patients colonized by MR, and 22/64 patients were colonized on admission and 19/64 during the ICU stay. The resistant microorganisms commonly isolated were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumanni. The use of antibiotics (fluoroquinolone and glycopeptide) and previous hospitalization in ICU were relevant in the occurrence of colonization (p = 0.001). It is concluded that colonization by resistant microorganisms is a consequent occurrence of infection in high-risk units, reaffirms the importance of surveillance of infections that drive. Active surveillance combined with previously identified risk factors can recognize patients at high risk of colonization and thus anticipate measures to prevent and MR detection.