Ventilator-associated pneumonia: incidence, microbial etiology and antimicrobial resistance profile
DOI:
https://doi.org/10.17058/reci.v11i4.16781Keywords:
Infecção hospitalar, Pneumonia associada à ventilação mecânica, Resistência bacteriana a drogas.Abstract
Background and Objectives: Infections caused by multi-drug resistant microorganisms have a great clinical and economic impact. The present study proposed to determine and assess ventilator-associated pneumonia (VAP) incidence in an Intensive Care Unit (ICU), to establish the profile of hospitalized patients and to determine the frequency of microorganisms isolated as well as their antimicrobial resistance profile. Methods: A descriptive, documental study, with a quantitative approach, carried out at a teaching hospital. Participants were all individuals admitted to the General ICU who developed VAP in 2018 and 2019. Results: During the study, 146 patients were diagnosed with VAP, with an incidence of 23.66/1000 patient-days on mechanical ventilation. The median age of patients was 52.5 years and most of them were man. One hundred and eight microorganisms were isolated in cultures, the majority being gram-negative bacteria. Non-fermenting bacteria were the most frequent (n=46; 42.6%), followed by enterobacteria (n=42; 38.9%). Staphylococcus aureus was the most frequent microorganism among gram-positive (n=17; 15.7%). The most frequent multi-drug resistant bacteria were Acinetobacter baumannii and Enterobacter spp. No microorganism showed colistin and vancomycin resistance. Patients infected with multidrug-resistant bacteria were hospitalized longer when compared to other patients. Conclusions: VAP incidence was high. The knowledge of the etiologic agents of VAP and their antimicrobial resistance profile is fundamental to support the elaboration of institutional treatment protocols as well as assist in empirical antibiotic therapy.
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Rodrigues YCSJ, Studart RMB, Andrade IRC et al. Ventilação mecânica: evidências para o cuidado de enfermagem. Esc Anna Nery. 2012;16(4):789-95. https://doi.org/10.1590/S1414-81452012000400021
Agência Nacional de Vigilância Sanitária (BR). Medidas de prevenção de infecção relacionada à assistência à saúde. Brasília: Anvisa; 2017. http://www.riocomsaude.rj.gov.br/Publico/MostrarArquivo.aspx?C=pCiWUy84%2BR0%3D
Marino PJ, Wise MP, Smith A et al. Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients. J Crit Care. 2017;39:149-155. https://doi.org/10.1016/j.jcrc.2017.02.020
Agência Nacional de Vigilância Sanitária (BR). Nota Técnica GVIMS/GGTES Nº 03/2019: Critérios Diagnósticos das Infecções Relacionadas à Assistência à Saúde. Brasília: Anvisa; 2019. https://ameci.org.br/wp-content/uploads/2019/02/nota-tecnica03-2019-GVIMS-GGTES-anvisa.pdf
Mota EC, Oliveira SP, Silveira BRM et al. Incidência da pneumonia associada à ventilação mecânica em unidade de terapia intensiva. Medicina (Ribeirao Preto, Online). 2017;50(1):39-46. https://doi.org/10.11606/issn.2176-7262.v50i1p39-46
Frota ML, Campanharo CRV, Lopes MCBT et al. Boas práticas para prevenção de pneumonia associada à ventilação mecânica no serviço de emergência. Rev Esc Enferm USP. 2019;53:1-8. https://doi.org/10.1590/S1980-220X2018010803460
Hespanhol LAB, Ramos SCS, Junior OCR et al. Infecção relacionada à Assistência à Saúde em Unidade de Terapia Intensiva Adulto. Enferm Glob. 2019;18(1):229-41. ISSN: 1695-6141. https://scielo.isciii.es/pdf/eg/v18n53/pt_1695-6141-eg-18-53-215.pdf
The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 10.0, 2020. http://www.eucast.org
Magiorakos AP, Srinivasan A, Carey RB et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x
Kock KS, Maurici R. Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit. World J Crit Care Med. 2018;7(1): 24-30. https://doi.org/10.5492/wjccm.v7.i1.24
Secretaria do Estado de Saúde do Paraná (Paraná). Boletim SONIH de janeiro a julho de 2018. Paraná: SES/Governo do Estado. https://www.sonih.saude.pr.gov.br/
Pereira FGF, Chagas ANS, Freitas MMC et al. Caracterização das infecções relacionadas à assistência à saúde em uma Unidade de Terapia Intensiva. Vigil Sanit Debate. 2016;4(1):70-77. https://doi.org/10.3395/2317-269x.00614
Ekren PK, Ranzani OT, Ceccato A et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU. Am J Respir Crit care med. 2018;197(6):826-30. https://doi.org/10.1164/rccm.201708-1717LE
Costa RS, Motta LCS, Alfradique MD. O perfil epidemiológico do paciente com pneumonia associada à ventilação mecânica. Rev Fac Med Teresópolis. 2018;2(2):93-112. http://www.revista.unifeso.edu.br/index.php/faculdadedemedicinadeteresopolis/article/view/1020
Rocha LA, Vilela CAP, Cezário RC et al. Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance. Braz J Infect Dis. 2008;12(1):80-85. https://doi.org/10.1590/S1413-86702008000100017
Resende MM, Monteiro SG, Callegari B et al. Epidemiology and outcomes of ventilator-associated pneumonia in northern Brazil: an analytical descriptive prospective cohort study. BMC Infect Dis. 2013;13:119. https://doi.org/10.1186/1471-2334-13-119
Amaral JM, Ivo OP. Prevenção de pneumonia associada à ventilação mecânica. Rev Enf Contemp. 2016;5(1):109-17. http://dx.doi.org/10.17267/2317-3378rec.v5i1.926
Oliveira ACS, Cunha TM, Passos LBS et al. Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates. Braz J Infect Dis. 2016;20(5):437-43. https://doi.org/10.1016/j.bjid.2016.06.006
Favarin SS, Camponogara S. Perfil dos pacientes internados na unidade de terapia intensiva adulto de um hospital universitário. Rev Enferm UFSM. 2012;2(2):320-29. https://doi.org/10.5902/217976925178
Watanabe EM, Almeida VF, Ottunes AF et al. Impacto das infecções relacionadas à assistência à saúde em pacientes acometidos por trauma. Semina Cienc Biol Saúde. 2015;36(1):89-98. http://dx.doi.org/10.5433/1679-0367.2015v36n1Suplp89
Seligman R, Seligman BGS, Teixeira PJZ. Comparação da acurácia de preditores de mortalidade na pneumonia associada a ventilação mecânica. J Bras Pneumol. 2011;97(4):495-503. https://doi.org/10.1590/S1806-37132011000400012
Braga IA, Campos PA, Gontijo-Filho PP et al. Multi-hospital point prevalence study of healthcare-associated infections in 28 adult intensive care units in Brazil. J Hosp Infect. 2018;99(3):318-24. https://doi.org/10.1016/j.jhin.2018.03.003
Mota FS, Oliveira HÁ, Souto RCF. Perfil e prevalência de resistência aos antimicrobianos de bactérias Gram-negativas isoladas de pacientes de uma unidade de terapia intensiva. Rev Bras Anal Clin. 2018;50(3):270-7. https://doi.org/10.21877/2448-3877.201800740
Tuon FF, Graf ME, Merlini A et al. Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae. Braz J Infect Dis. 2017;21(1):1-6. https://doi.org/10.1016/j.bjid.2016.09.008
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;48:888-906. https://doi.org/10.1007/s00134-020-05980-0
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