Dissertação de mestrado

Avaliação das infecções de sítio cirúrgico e do trato urinário em pacientes submetidos a transplante simultâneo de rim-pâncreas

Fecha
2008
Registro en:
São Paulo: [s.n.], 2008. 109 p.
epm-9031817000643.pdf
Publico-24235.pdf
Objectives: The study aimed at determining the risk factors associated with surgical site infection (SSI) and urinary tract infection (UTI) after simultaneous pancreaskidney transplantation (SPKT). We also studied the incidence of surgical site infection and urinary tract infection in this patient cohort and the major pathogens responsible for such infections. Method: The study was conducted at Hospital São Paulo, a tertiary care teaching hospital belonged to Federal University of São Paulo, using a cohort of patients who underwent simultaneous kidney-pancreas transplantation in the period from December 1, 2000 to December 31, 2006. The patients were accompanied based on their medical records, for a period of one month post-transplantation, for the development of surgical site infection, and during the overall post-transplant hospitalization period for the development of nosocomial urinary tract infection. The diagnosis of nosocomial infection was based on the criteria defined by the Center for Disease Control and Prevention (CDC). In addition, two nested case control studies were conducted to assess the risk factors for surgical site infection and urinary tract infection in this patient cohort. The multivariate analysis was performed using multiple logistic regression of the variables with p≤ 0.05 in the univariate analysis. The stepwise forward method was used. Results: 119 SPKT were evaluated. The 30-day mortality rate was 11.8%. Surgical site infection occurred in 55 (46.2%) patients submitted to transplantation. The major microorganisms were: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11%). After multivariate logistic regression, the variables independently associated with SSI were: acute tubular necrosis (OR=4.4; CI95%= 1.77 – 10.99; p=0.001); posttransplant renal or pancreatic fistula (OR=7.25; CI95%= 1.35 – 38.99; p=0.02), and graft rejection (OR=4.28; CI95%= 1.59 – 11.48; p=0.004). Urinary tract infection occurred in 29 (24.4%) patients submitted to transplantation. The major microorganisms were: Klebsiella pneumoniae 13 (43.5%), Acinetobacter baumannii 7 (23.5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%). After multivariate logistic regression, the variables independently associated with UTI were: duration of hypertension (OR=1.1; CI95%= 1.00 – 1.02; p=0.01); use of alcohol by the donor (OR=7.49; CI95%= 1.01 – 55.66; p=0.04) and use of vasoactive drugs in the donor (OR=0.08; CI95%= 0.01 – 0.84; p=0.03), and, as a protecting factor, residual pre-transplant diuresis (OR=0.16; CI95%= 0.04 – 0.59; p=0.006). Conclusion: Our study showed that variables related to the surgical procedure are more closely associated with the development of surgical site infection and variables related to the recipient and to the donor are more closely related to the occurrence of urinary tract infection, in patients submitted to simultaneous pancreas-kidney transplantation. Our study is one of the first attempts at assessing risk factors for these two important nosocomial infections in this patient cohort.
Autor
Perdiz, Luciana Baria [UNIFESP]
Institución
Resumen
Objetivos: 0 estudo procurou determinar os fatores de risco associados a infeccao de sitio cirurgico e do trato urinario pos-transplante simultaneo de rim-pancreas. Foi tambem estudada a incidencia de infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes e os principais patogenos causadores destas infeccoes. Metodo: 0 estudo foi realizado no Hospital São Paulo, hospital terciario de ensino da Universidade Federal de São Paulo. 0 estudo utilizou uma coorte de pacientes que incluiu todos os pacientes que realizaram transplante simultaneo de rim-pancreas no periodo de 01 de dezembro de 2000 a 31 de dezembro de 2006 (119 receptores). Estes pacientes foram acompanhados atraves do prontuario, por um periodo de um mes pos-transplante, para desenvolvimento de infeccao de sitio cirurgico, e durante todo 0 periodo de internacao apos 0 transplante para 0 desenvolvimento de infeccao do trato urinario hospitalar. Os criterios usados para 0 diagnostico de infeccao hospitalar foram definidos pelo Centers for Disease Control and Prevention (CDC). E foram realizados dois estudos tipo caso-controle aninhado (do ingles Nested Case Control), onde foram avaliados os fatores de risco para infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes. A analise multivariada foi realizada pela tecnica de regressao logistica multipla, utilizando as variaveis com p≤ 0,05 na analise univariada. 0 metodo utilizado foi 0 Stepwise forward. Resultados: A mortalidade nos primeiros 30 dias apos 0 transplante foi 11,8%. A infeccao de sitio cirurgico ocorreu em 55 (46,2%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11 %). Ap6s a regressao logistica multivariada, as variaveis independentemente associadas a ISC foram: necrose tubular aguda (OR=4,4; IC95%= 1,77 - 10,99; p=0,001); fistula renal ou pancreatica pos-­transplante (OR=7,25; IC95%= 1,35 - 38,99; p=0,02) e rejeicao do enxerto (OR=4,28; IC95%= 1,59 - 11,48; p=0,004). A infeccao do trato urinario ocorreu em 29 (24,4%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae 13 (43,5%), Acinetobacter baumannii 7 (23,5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%).Apos a regressao logistica multivariada, as variaveis independentemente associadas a ITU foram: tempo de hipertensao arterial (OR=1, 1; IC95%= 1,00 - 1,02; p=0,01); uso de alcool pelo doador (OR=7,49; IC95%= 1,01 - 55,66; p=0,04) e uso de drogas vasoativas no doador (OR=0,08; IC95%= 0,01 - 0,84; p=0,03) e, como fator protetor: diurese residual pre-transplante (OR=0,16; IC95%= 0,04 - 0,59; p=0,006). Conclusao: Nosso estudo demonstrou que variaveis relacionadas ao procedimento cirurgico estao mais relacionadas ao desenvolvimento de infeccao de sitio cirurgico e que variaveis relacionadas ao receptor e doador estao mais relacionadas ao surgimento de infeccao do trato urinario em pacientes submetidos a transplante simultaneo rim­-pancreas. Nosso estudo e um dos primeiros a avaliar fatores de risco para essas duas importantes infeccoes nosocomiais nessa coorte de pacientes.
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