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Infeções associadas aos cuidados de saúde numa Unidade de Cuidados Intensivos Pediátricos : estudo comparativo 2013-2020
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Introdução: As Infeções Associadas aos Cuidados de Saúde (IACS) são infeções documentadas após 48 horas de internamento e representam um problema crescente nas Unidades de Cuidados Intensivos Pediátricas (UCIPed), por contribuírem para um aumento da morbimortalidade, com internamentos prolongados. A vigilância epidemiológica é essencial para controlar e prevenir as IACS.
Objetivos: Este trabalho teve como principal objetivo o estudo casuístico da UCIPed do HSM-CHULN, relativamente às IACS. Os objetivos secundários foram a comparação com um estudo semelhante de 2013, para otimização das medidas preventivas na UCIPed e uma breve revisão teórica do tema.
Material e Métodos: Estudo descritivo com revisão retrospetiva das IACS, considerando os doentes internados durante mais de 48 horas na UCIPed em 2020. Foram utilizados os critérios do Programa HELICS-UCI da DGS, estratificando as IACS em quatro subtipos: pneumonia, traqueobronquite, bacteriemia e infeção do trato urinário (ITU). Compararam-se os resultados com um estudo de 2013, realizado na mesma unidade. Para a revisão teórica, fez-se pesquisa bibliográfica no PubMed, Google Scholar, com seleção de publicações de artigos de revisão ou casuísticas.
Resultados: Em 2020 ocorreram 333 internamentos na UCIedP do HSM-CHULN, dos quais 164 foram incluídos no estudo por terem internamentos superiores a 48 horas. A duração média do internamento foi de 10,8 dias. 54% fez ventilação mecânica, 35% invasivamente; 44% teve CVC e 68% teve cateter urinário. A mortalidade foi de 45%.
Foram identificadas 25 IACS em 13 doentes: 14 infeções respiratórias, 7 bacteriemias e 4 ITU. Seis doentes tinham mais do que uma IACS. A duração média do internamento foi de 34,5 dias, 3 doentes faleceram (23% mortalidade). Houve multirresistência em 28% dos agentes.
Conclusão: Os resultados obtidos foram semelhantes aos de outras UCIPed europeias. Comparativamente a 2013, objetivou-se uma maior incidência de IACS, mas uma redução das IACS respiratórias, possivelmente explicada pelas medidas adotadas em contexto da pandemia SARS-CoV-2. Os doentes com IACS tiveram um internamento prolongado e uma maior taxa de mortalidade.
Introduction: Healthcare-associated Infections (HAI), which occur in patients admitted to the hospital for more than 48, are increasing in Pediatric Intensive Care Units (PICU), contributing to a higher morbidity and mortality rates, as well as prolonged hospitalization. Epidemiological surveillance is essential for the control of HAI. Objectives: Study the case series of HAI in the PICU of HSM-CHULN; compare the results to a similar 2013 study; discuss preventive measures that could be applied in this unit; review current guidelines and scientific evidence on HAI. Methods: Retrospective review of clinical data of all patients hospitalized longer than 48 hours at the PICU of HSM-CHULN, in 2020. HAI were identified according to the criteria defined by the HELICS-UCI program of DGS, stratifying them in four categories: pneumonia, tracheobronchitis, bloodstream infection and urinary tract infection (UTI). The obtained results were compared to a similar 2013 study. A review on HAI was made, using PubMed and Google Scholar. Results: 333 patients were admitted in 2020, and 164 of them were included due to more than 48 hours of hospitalization. The average length of stay was 10.8 days. 54% were mechanically ventilated (35% invasive); 44% had CVC and 68% had a bladder catheter. The mortality rate was 5%. 25 HAI were identified in 13 patients: 14 respiratory infections, 7 bloodstream infections and 4 UTI. The average length of stay was 34.5 days. The mortality rate was 23%. 28% of the identified bacteria were multiresistant. Conclusion: These results were similar to those obtained in other European PICU. There was an increase in the incidence of HAI, compared to 2013, but a reduction of respiratory infections, possibly explained by the adoption of measures related to the SARS-CoV-2 pandemic. HAI patients had prolonged hospitalization, as well as bigger mortality rates.
Introduction: Healthcare-associated Infections (HAI), which occur in patients admitted to the hospital for more than 48, are increasing in Pediatric Intensive Care Units (PICU), contributing to a higher morbidity and mortality rates, as well as prolonged hospitalization. Epidemiological surveillance is essential for the control of HAI. Objectives: Study the case series of HAI in the PICU of HSM-CHULN; compare the results to a similar 2013 study; discuss preventive measures that could be applied in this unit; review current guidelines and scientific evidence on HAI. Methods: Retrospective review of clinical data of all patients hospitalized longer than 48 hours at the PICU of HSM-CHULN, in 2020. HAI were identified according to the criteria defined by the HELICS-UCI program of DGS, stratifying them in four categories: pneumonia, tracheobronchitis, bloodstream infection and urinary tract infection (UTI). The obtained results were compared to a similar 2013 study. A review on HAI was made, using PubMed and Google Scholar. Results: 333 patients were admitted in 2020, and 164 of them were included due to more than 48 hours of hospitalization. The average length of stay was 10.8 days. 54% were mechanically ventilated (35% invasive); 44% had CVC and 68% had a bladder catheter. The mortality rate was 5%. 25 HAI were identified in 13 patients: 14 respiratory infections, 7 bloodstream infections and 4 UTI. The average length of stay was 34.5 days. The mortality rate was 23%. 28% of the identified bacteria were multiresistant. Conclusion: These results were similar to those obtained in other European PICU. There was an increase in the incidence of HAI, compared to 2013, but a reduction of respiratory infections, possibly explained by the adoption of measures related to the SARS-CoV-2 pandemic. HAI patients had prolonged hospitalization, as well as bigger mortality rates.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Infeções associadas aos cuidados de saúde Unidade de cuidados intensivos pediátricas (UCIPed) Pediatria