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Prevalência e etiologia de sepse neonatal e perfil de suscetibilidade antimicrobiana dos patógenos: estudo numa Unidade de Terapia Intensiva Neonatal em Curitiba, BR.
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| DM_33225 | 1.19 MB | Adobe PDF |
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Abstract(s)
A sepse neonatal é um problema mundial, sendo a incidência desta doença em países desenvolvidos de 1/1.000 em recém-nascidos atermos e 4/1.000 em neonatos prematuros.
Neste estudo foram analisados ficheiros de uma Unidade de Tratamento Intensivo Neonatal (UTIN) Brasil no período de 2014 a 2016. Das 520 hemoculturas de recém-nascidos internados na UTIN, 73 apresentaram hemocultura positiva e foram também analisados os respetivos 73 antibiogramas. Todos os resultados foram fornecidos pelo laboratório responsável pelo serviço de análises do Hospital, o qual realizou as respectivas análises.
Das hemoculturas positivas, 74% foram identificadas como bactérias de Gram positivo, e a espécie de Staphylococcus epidermidis foi a predominante (58,9% do total de infeções e 79,6% dentre as de Gram positivo) e 26% corresponderam a espécies de Gram negativo e Klebsiella pneumoniae foi a predominante (9,6% do total de infeções e com incidência de 36,8% dentre o grupo de Gram negativo). Os antibióticos que se mostraram mais efetivos no tratamento de infeções de bactérias de Gram positivo foram a vancomicina que foi o único antibiótico utilizado em grande escala (n=53) que não sofreu resistência de nenhuma bactéria de Gram positivo, além da clindamicina com um índice de resistência de 15,7% das bactérias de Gram positivo. Já para bactérias de Gram negativo, é notado que a classe de antibióticos carbapenemos como o imipenemo, o meropenemo e ertapenemo foram muito efetivos no tratamento destas infeções, onde as bactérias não apresentaram nenhuma resistência, assim como para a amicacina. O uso de quinolonas como a ciprofloxacina e levofloxacina não foram tão eficientes, com resistências entre 11,1 e 15,8%. Os resultados indicam que melhorias no cuidado da instalação e manipulação de cateteres umbilicais e venosos na instituição do estudo podem trazer resultados diretos na diminuição de casos de sepse, Staphylococcus epidermidis foi o microrganismo de maior incidência e possui como fonte de contaminação mais frequente este tipo de acesso. Mais estudos sobre a suscetibilidade a antibióticos dos microrganismos que causam sepse neonatal são necessários para melhorar o tratamento empírico e evitar o aparecimento de resistências. É necessário e urgente o desenvolvimento de mais estratégias para promover a utilização racional de antibióticos pelos prescritores e utilizadores, de modo a diminuir o problema gravíssimo das resistências bacterianas a nível mundial.
In the whole world, Neonatal sepsis occurrence in developed countries is 1/1000 in aterms newborns whereas in premature newborns is 4/1000. In this study, data from blood cultures from an Intensive Care Neonatal Unit from a Hospital in Brazil in the period between 2014 and 2016 were evaluated. From the 520 blood cultures of the hospitalized newborns, 73 presented positive results for blood culture, for all the cases the pathogen microorganism was identified and antibiograms were performed to determine antibiotic susceptibility profiles. 74% of cases were positive to Gram-positive bacteria, Staphylococcus epidermidis was the most common bacteria (58.9% of total cases and 79.6% among the Gram-positive), while 26% of the infections where related to Gram-negative bacteria, where Klebsiella pneumoniae was the most commom one (9.6% of total cases and 36.8% among Gram-negative). The most effective antibiotics to treat Gram-positive bacterial infections was vancomycin (glycopeptide), which was the only highly used antibiotic (n=53) to whom all Gram-positive bacteria presented no resistance, and clindamycin, which suffered resistance in 15.7% of cases. In the Gram-negative bacteria infections, the carbapenems, as imipenem, meropenem and ertapenem and aminoglycosides as amikacin were highly effective and none of the Gram-negative bacteria were resistant to them. Quinolones as ciprofloxacin and levofloxacin weren’t as efficient, the Gram-negative bacteria presented resistances rates between 11.1 and 15.8%. Staphylococcus epirdermidis was the most frequent bacteria causing sepsis, showing that improvements on central line catheter installation and care could reduce significally sepsis frequency as these bacteria most commom infection source is central line catheter use and handling. Neonatal infection bacteria resistant studies are needed to improve the empirical treatment and avoid the rise of antibiotic resistance. It’s urgently needed the development of more strategies to promote a rational usage of antibiotics by prescribers and users to decrease the bacterial antibiotic resistance all over the globe.
In the whole world, Neonatal sepsis occurrence in developed countries is 1/1000 in aterms newborns whereas in premature newborns is 4/1000. In this study, data from blood cultures from an Intensive Care Neonatal Unit from a Hospital in Brazil in the period between 2014 and 2016 were evaluated. From the 520 blood cultures of the hospitalized newborns, 73 presented positive results for blood culture, for all the cases the pathogen microorganism was identified and antibiograms were performed to determine antibiotic susceptibility profiles. 74% of cases were positive to Gram-positive bacteria, Staphylococcus epidermidis was the most common bacteria (58.9% of total cases and 79.6% among the Gram-positive), while 26% of the infections where related to Gram-negative bacteria, where Klebsiella pneumoniae was the most commom one (9.6% of total cases and 36.8% among Gram-negative). The most effective antibiotics to treat Gram-positive bacterial infections was vancomycin (glycopeptide), which was the only highly used antibiotic (n=53) to whom all Gram-positive bacteria presented no resistance, and clindamycin, which suffered resistance in 15.7% of cases. In the Gram-negative bacteria infections, the carbapenems, as imipenem, meropenem and ertapenem and aminoglycosides as amikacin were highly effective and none of the Gram-negative bacteria were resistant to them. Quinolones as ciprofloxacin and levofloxacin weren’t as efficient, the Gram-negative bacteria presented resistances rates between 11.1 and 15.8%. Staphylococcus epirdermidis was the most frequent bacteria causing sepsis, showing that improvements on central line catheter installation and care could reduce significally sepsis frequency as these bacteria most commom infection source is central line catheter use and handling. Neonatal infection bacteria resistant studies are needed to improve the empirical treatment and avoid the rise of antibiotic resistance. It’s urgently needed the development of more strategies to promote a rational usage of antibiotics by prescribers and users to decrease the bacterial antibiotic resistance all over the globe.