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Infecções nosocomiais numa unidade de cuidados intensivos pediátrica portuguesa
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Introdução: As crianças internadas em unidades de cuidados intensivos pediátricas estão sujeitas a um risco acrescido de infecções nosocomiais, nomeadamente bacteriémias, infecções do tracto respiratório, e infecções do tracto urinário, que têm sido frequentemente relacionadas com a utilização de dispositivos invasivos. O objectivo deste estudo foi estimar a incidência destes tipos de infecções nosocomiais nos doentes internados numa Unidade de Cuidados Intensivos Pediátrica portuguesa.
Material e métodos: Foram incluídos os doentes internados na UCIPed do HSM, por um período superior a 48 horas, durante o ano de 2017. Foi utilizada a definição de infecção nosocomial do CDC, ou seja, que tenha ocorrido após 48 horas de admissão. Foram analisados dados demográficos, clínicos e microbiológicos.
Resultados: Durante este período, foram elegíveis para estudo 185 admissões. No total, ocorreram 19 infecções nosocomiais em 14 doentes, sendo a incidência de infecção nosocomial 10,3% (19/185). Destas, 6 eram bacteriémias, 4 pneumonias, 6 traqueobronquites e 3 infecções do tracto urinário. Dezoito dos 19 doentes infectados tinham um dispositivo invasivo (cateter central, tubo endotraqueal ou cateter urinário). A duração mediana global de internamento foi de 4 dias e entre os infectados foi de 16,5 dias. A taxa de mortalidade global foi de 7% e entre os infectados de 10,5%. A maioria dos agentes isolados eram gram negativos e 19% (4) eram multirresistentes.
Conclusão: As infecções do tracto respiratório foram o tipo de infecção nosocomial mais frequente. As infecções nosocomiais contribuíram para um prolongamento da duração de internamento e para uma elevação da taxa de mortalidade e estiveram quase sempre associadas a dispositivos invasivos. Os dispositivos devem ser retirados assim que possível.
Introduction: Children admitted at pediatric intensive care units are prone to an increased risk of nosocomial infections, including bacteremia, respiratory infections, and urinary tract infections, which have been frequently related to the use of invasive devices. This study’s goal was to estimate these type of infection’s incidence on patients that were admitted to a portuguese pediatric intensive care unit. Material and methods: Patients that were included in the study were admitted to Hospital de Santa Maria’s PICU for a period of time superior to 48 hours, during the civil year of 2017. The CDC’s definition of nosocomial infection was used, wich is an infection that ocurred after 48 hours of admission. Demografic, clinical and microbiological data were analysed. Results: During this period of time, 185 admissions were elected to this study. There was a total of 19 nosocomial infections in 14 patients, with the incidence of nosocomial infection being 10,3% (19/185). Among these, 6 were bacteremias, 4 pneumonias, 6 tracheobronchitis, and 3 urinary tract infections. Eighteen of the 19 infected patients had an invasive device (central venous catheter, endotraqueal tube, or urinary cateter). The global median length of stay was 4 days, and among the infected patients was 16,5 days. The global mortality rate was 7%, and among the infected ones, it was 10,5%. The majority of isolated microbiological agents were gram negative, and 19% (4) were multirresistant. Conclusion: Respiratory tract infections were the most frequent nosocomial infection. Nosocomial infections contributed to an increase in the length of stay and to an elevation in the mortality rate, and were almost always associated to invasive devices. Invasive devices should be removed as soon as possible.
Introduction: Children admitted at pediatric intensive care units are prone to an increased risk of nosocomial infections, including bacteremia, respiratory infections, and urinary tract infections, which have been frequently related to the use of invasive devices. This study’s goal was to estimate these type of infection’s incidence on patients that were admitted to a portuguese pediatric intensive care unit. Material and methods: Patients that were included in the study were admitted to Hospital de Santa Maria’s PICU for a period of time superior to 48 hours, during the civil year of 2017. The CDC’s definition of nosocomial infection was used, wich is an infection that ocurred after 48 hours of admission. Demografic, clinical and microbiological data were analysed. Results: During this period of time, 185 admissions were elected to this study. There was a total of 19 nosocomial infections in 14 patients, with the incidence of nosocomial infection being 10,3% (19/185). Among these, 6 were bacteremias, 4 pneumonias, 6 tracheobronchitis, and 3 urinary tract infections. Eighteen of the 19 infected patients had an invasive device (central venous catheter, endotraqueal tube, or urinary cateter). The global median length of stay was 4 days, and among the infected patients was 16,5 days. The global mortality rate was 7%, and among the infected ones, it was 10,5%. The majority of isolated microbiological agents were gram negative, and 19% (4) were multirresistant. Conclusion: Respiratory tract infections were the most frequent nosocomial infection. Nosocomial infections contributed to an increase in the length of stay and to an elevation in the mortality rate, and were almost always associated to invasive devices. Invasive devices should be removed as soon as possible.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Unidade de cuidados intensivos pediátrica Infecção nosocomial Dispositivos invasivos Pediatria