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Infeções por Enterobacter cloacae, Serratia marcescens e Stenotrophomonas maltophilia numa unidade de cuidados intensivos pediátricos
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Introdução: As infecções associadas aos cuidados de saúde (IACS) nas unidades de cuidados intensivos pediátricos (UCIP) constituem um problema de saúde major. Nos últimos anos têm sido descritos na literatura vários surtos associados a alguns agentes gram-negativos, que não eram comuns enquanto agentes de infecção nestas unidades. O objetivo deste estudo foi analisar a tendência das IACS originadas por três destes agentes na UCIP do Hospital de Santa Maria (UCIPed). Esses agentes são: Enterobacter cloacae (E.cloacae), Serratia marcescens (S.marcescens) e Stenotrophomonas maltophilia (S.maltophilia). Material e métodos: Neste estudo foram analisadas as infecções respiratórias, da corrente sanguínea e do trato urinário originadas por estes três agentes, durante o período de 2018 a 2022. Foram incluídos os doentes internados por um período superior a 48 horas e analisados os dados segundo critérios demográficos, clínicos e microbiológicos. Resultados: Durante o período de 2018 a 2022 verificou-se um total de 1773 admissões. Constataram-se 27 isolamentos dos três agentes em estudo, em 23 doentes: 12 (44,4%) isolamentos de E.cloacae, 8 (29,6%) isolamentos de S.maltophilia e 7 (25,9%) isolamentos de S.marcescens. Em 2018 não se verificaram infecções por estes agentes. A distribuição ao longo dos restantes anos foi de 3 isolamentos em 2019, 5 isolamentos em 2020, 10 isolamentos em 2021 e 9 isolamentos em 2022. Os doentes internados tinham uma mediana de idades de 25 dias (1 dia-17 anos) e a duração mediana de internamento foi de 24 dias (5-133). A grande maioria dos doentes (22 - 95,7%) tinha doença crónica e estava sob antibioticoterapia prévia ao isolamento (22 - 95,7%). Todos os doentes estavam ventilados invasivamente e tinham CVC, 20 doentes (87%) tinham cateter vesical; 12 doentes (52,2%) estavam em ECMO. Todos os doentes tinham falência de um órgão e mais de metade tinha falência multiorgânica (14 - 60,9%). Verificaram-se 3 óbitos, o que correspondeu a uma mortalidade de 13%. Conclusão: Tem existido um aumento no número de infeções associadas a estes agentes, o que vai de encontro aos surtos descritos na literatura. A complexidade dos doentes e o internamento prolongado contribuíram provavelmente para este aumento, pelo que nestes doentes as medidas básicas de prevenção de infecção devem ser ainda mais reforçadas e controladas periodicamente.
Introduction: Nosocomial infections in pediatric intensive care units are a major health issue. In the last years, there have been multiple outbreaks concerning some gram-negative agents that were not common in the PICUs. The goal of this study was to analyze the evolution of nosocomial infections originated by three of those agents in the PICU of Hospital of Santa Maria: Enterobacter cloacae (E.cloacae), Serratia marcescens (S.marcescens) and Stenotrophomonas maltophilia (S.maltophilia). Material and methods: In this study were included infections of the respiratory tract, blood stream and infections of the urinary tract originated by those 3 agents, between the period of 2018 and 2022. We included the patients that were admitted in the PICU for a period of more than 48 hours and the data was analyzed according to demographic, clinic and microbiology criteria. Results: Between 2018 and 2022 there were 1773 admissions. We had a total of 27 isolations of the 3 agents of study in 23 patients. 12 (44,4%) isolations of E.cloacae, 8 (29,6%) of isolations of S.maltophilia and 7 (25,9%) of isolations of S.marcescens. The distribution over the years was: 3 isolations in 2019, 5 isolations in 2020, 10 isolations 3 in 2021 and 9 isolations in 2022. The patients had a median age of 25 days (1 day-17 years) and the length of stay in the PICU had a median duration of 24 days (5-133). The vast majority (22 - 95,7%) were chronic patients and had done antibiotic therapy previously. All patients were ventilated and had a CVC and 20 (87%) of them had a urinary catheter; 12 patients (52,5%) were on ECMO. All patients had at least one organ failure and 14 (60,9%) had multiple organ failure. The mortality was 13% (3 patients). Conclusions: The number of infections related to these agents has been rising in the last years, as has been described in recent literature. The complexity of the patients and a long duration of hospitalization probably contributed to this rise, which means that basic measures of prevention should be even more reinforced and controlled periodically in these cases.
Introduction: Nosocomial infections in pediatric intensive care units are a major health issue. In the last years, there have been multiple outbreaks concerning some gram-negative agents that were not common in the PICUs. The goal of this study was to analyze the evolution of nosocomial infections originated by three of those agents in the PICU of Hospital of Santa Maria: Enterobacter cloacae (E.cloacae), Serratia marcescens (S.marcescens) and Stenotrophomonas maltophilia (S.maltophilia). Material and methods: In this study were included infections of the respiratory tract, blood stream and infections of the urinary tract originated by those 3 agents, between the period of 2018 and 2022. We included the patients that were admitted in the PICU for a period of more than 48 hours and the data was analyzed according to demographic, clinic and microbiology criteria. Results: Between 2018 and 2022 there were 1773 admissions. We had a total of 27 isolations of the 3 agents of study in 23 patients. 12 (44,4%) isolations of E.cloacae, 8 (29,6%) of isolations of S.maltophilia and 7 (25,9%) of isolations of S.marcescens. The distribution over the years was: 3 isolations in 2019, 5 isolations in 2020, 10 isolations 3 in 2021 and 9 isolations in 2022. The patients had a median age of 25 days (1 day-17 years) and the length of stay in the PICU had a median duration of 24 days (5-133). The vast majority (22 - 95,7%) were chronic patients and had done antibiotic therapy previously. All patients were ventilated and had a CVC and 20 (87%) of them had a urinary catheter; 12 patients (52,5%) were on ECMO. All patients had at least one organ failure and 14 (60,9%) had multiple organ failure. The mortality was 13% (3 patients). Conclusions: The number of infections related to these agents has been rising in the last years, as has been described in recent literature. The complexity of the patients and a long duration of hospitalization probably contributed to this rise, which means that basic measures of prevention should be even more reinforced and controlled periodically in these cases.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Infeção associada aos cuidados de saúde Unidade de cuidados intensivos pediátrica Enterobacter cloacae Stenotrophomonas maltophilia Serratia marcescens Pediatria