Bloodstream infection and multidrug resistance in the Intensive Care Unit
DOI:
https://doi.org/10.30968/rbfhss.2024.151.0957Abstract
Objective: To identify bacterial species and the antimicrobial resistance rate in blood culture samples from patients admitted to an adult ICU. Methods: This is an observational and retrospective study, carried out in a tertiary hospital in the Northwest of Minas Gerais, Brazil, between January 1, 2019 and October 31, 2022. Data were obtained from records in the database of blood cultures and electronic medical records of patients admitted to the hospital’s adult ICU. Results: From 2019 to 2022, Gram positive bacteria were the most isolated, however, a gradual reduction was observed over the years, in parallel with the growth in Gram negative etiology in this period. The frequently isolated microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus spp, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. Staphylococcus aureus showed low resistance to methicillin, contrary to the results observed in coagulase-negative staphylococcal strains. Resistance rates ≥50% were identified to at least three classes of antimicrobials tested in Gram-negative bacteria, namely Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii, Klebsiella ozaenae and Serratia spp. Conclusion: The results indicated multidrug resistance at the study institution, especially concerning in Gram-negative strains.
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Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Manual; 2023. Disponível em: https://www.cdc.gov/nhsn/psc/index.html. Acesso em: 07 de janeiro de 2023.
Lim SJ, Choi JY, Lee SJ, et al. Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea. Infection. 2014;42(5):875-81. DOI: 10.1007/s15010-014-0651-z.
Harte J, Soothill G, Samuel JGD, et al. Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit. Crit Care Res Pract. 2021;2021:3652130. DOI: 10.1155/2021/3652130.
Timsit JF, Ruppé E, Barbier F, et al. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med. 2020;46(2):266-284. DOI: 10.1007/s00134-020-05950- 6.
World Health Organization. Global action plan on antimicrobial resistance. Geneva, Switzerland: WHO; 2015.
Pillonetto M, Jordão RT de S, Andraus GS, et al. The Experience of Implementing a National Antimicrobial Resistance Surveillance System in Brazil. Frontiers in Public Health. 2021. DOI: 10.3389/fpubh.2020.575536.
Harassim L, Silva OLF, Pinheiro, LFS, et al. Fatores de risco e perfil do uso de antimicrobianos entre pacientes com infecção no trato urinário em uma unidade de terapia intensiva. Research, Society and Development. 2021. DOI: 10.33448/rsd-v10i3.13516.
Veloso LC., Alves GC., Carvalho LG, et al. Avaliação do perfil de resistência e sensibilidade antimicrobiana em casos de infecção do trato urinário no CTI em cidade do interior de Minas Gerais. Rev Med Minas Gerais. 2022. 32(Supl 06), S44-S53.
BRAGA, IA. Estudo multicêntrico de infecções relacionadas à assistência à saúde em unidades de terapia intensiva de adultos no Estado de Minas Gerais. Tese (Doutorado) – Universidade Federal de Uberlândia, Programa de Pós-Graduação em Ciências da Saúde. 2019. DOI 10.14393/ufu.te.2019.1243
Jim O´Neill. Antimicrobial Resistance: tacking a crisis for the health and wealth of nations. Review on Antimicrobial Resistence. 2014. Disponível em: https://wellcomecollection.org/ works/rdpck35v. Acesso em: 07 de fevereiro de 2023.
Agência Nacional de Vigilância Sanitária. NOTA TÉCNICA GVIMS/GGTES Nº 07/2021. Critérios diagnósticos das Infecções Relacionadas à Assistência à Saúde (IRAS): notificação nacional obrigatória para o ano de 2022. Brasília. 2021. 96p.
Ansari S., Hays J. P., Kemp A., et al. The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: an AMR Insights global perspective. JAC Antimicrob Resist. 2021; 3(2):dlab038. DOI: 10.1093/jacamr/dlab038.
Malik SS, Mundra S. Increasing Consumption of Antibiotics during the COVID-19 Pandemic: Implications for Patient Health and Emerging Anti-Microbial Resistance. Antibiotics (Basel). 2022; 12(1):45. DOI: 10.3390/antibiotics12010045.
Duan N, Sun L, Huang C, et al. Microbial Distribution and Antibiotic Susceptibility of Bloodstream Infections in Different Intensive Care Units. Front Microbiol. 2021; 12:792282. DOI: 10.3389/fmicb.2021.792282.
Guzek A, Rybicki Z, Woźniak-Kosek A, et al. Bloodstream Infections in the Intensive Care Unit: a Single-Center Retrospective Bacteriological Analysis Between 2007 and 2019. Pol J Microbiol. 2022; 71(2):263-277. DOI: 10.33073/pjm-2022-025.
Marra, A. R., Camargo, L. F., Pignatari, A. C., et al. Nosocomial bloodstream infections in Brazilian hospitals: análisis of 2,563 cases from a prospective nationwide surveillance study. J Clin Microbiol. 2011; 49(5):1866-71. DOI: 10.1128/JCM.00376-11.
Sabino SS, Lima CA, Machado LG, et al. Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty- day mortality among patients with bloodstream infections. Rev Soc Bras Med Trop. 2020; 53:e20190106. DOI: 10.1590/0037-8682-0106-2019.
Beganovic M, Cusumano JA, Lopes V, et al. Comparative Effectiveness of Exclusive Exposure to Nafcillin or Oxacillin, Cefazolin, Piperacillin/Tazobactam, and Fluoroquinolones Among a National Cohort of Veterans With Methicillin-Susceptible Staphylococcus aureus Bloodstream Infection. Open Forum Infect Dis. 2019; 6(7):ofz270. DOI: 10.1093/ofid/ofz270.
Pedroso, S. H. S. P., Sandes, S. H. C., Filho, R. A. T., et al. Coagulase-Negative Staphylococci Isolated from Human Bloodstream Infections Showed Multidrug Resistance Profile. Microb Drug Resist. 2018; 24(5):635-647. DOI: 10.1089/mdr.2017.0309.
Fraser, Susan L. Enterococcal Infections Treatment & Management: Medical Care, Surgical Care, Consultations. 2023. Disponível em: https://emedicine.medscape.com/article/216993-treatment. Acesso em: 07 de fevereiro de 2023.
Chaves, F., Garnacho-Montero, J., Del Pozo, J. L., et al. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018; 42(1):5-36. DOI: 10.1016/j.medin.2017.09.012.
Gales AC, Castanheira M, Jones RN, et al. Antimicrobial resistance among Gram- negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010). Diagn Microbiol Infect Dis. 2012; 73(4):354-60. DOI: 10.1016/j.diagmicrobio.2012.04.007.
Kern WV, Rieg S. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect. 2020; 26(2):151-157. DOI: 10.1016/j.cmi.2019.10.031.
Bartolleti, F., Seco, B. M., Capuzzo Dos Santos, C., et al. Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae, São Paulo, Brazil. Emerg Infect Dis. 2016;22(10):1849-51. DOI: 10.3201/eid2210.160695.
Tsuji, B. T., Pogue, J. M., Zavascki, A. P., et al. International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy. 2019; 39(1):10-39. DOI: 10.1002/phar.2209.
Rodríguez-Baño J, Gutiérrez-Gutiérrez B, Machuca I, Pascual A. Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase- Producing Enterobacteriaceae. Clin Microbiol Rev. 2018; 31(2):e00079-17. DOI: 10.1128/CMR.00079-17/
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