Bacteriological profile analysis of patients admitted to intensive care regarding morbidity and mortality: A longitudinal study

Authors

DOI:

https://doi.org/10.21527/2176-7114.2024.48.14017

Keywords:

microbiology, hospital-acquired infection, microbial drug resistance, intensive care units, patient safety

Abstract

Objective: To analyze the bacteriological profile of patients admitted to an intensive care unit and its association with morbidity and mortality. Method: An observational, longitudinal study with a sample of 180 patients admitted to an intensive care unit. Data collection occurred through consultation of the clinical bacteriology laboratory database and electronic medical records between May and July 2022. The Kaplan-Meier method was used for survival analysis. Results: Klebsiella pneumoniae (46.38%) was the most prevalent microorganism, with resistance rates of 90.6% for cefepime, 84.4% for cefotaxime, 84.4% for ceftazidime, 84.4% for ciprofloxacin, and 84.4% for piperacillin + tazobactam. The study showed that with each day of hospitalization, the chance of the patient presenting a positive blood culture increased by 4.1% (p-value <0.001).  Regarding mortality, 85 patients died, with 34 (62.96%) having a positive blood culture. The presence of microorganisms in blood cultures increased the risk of death by 2.5 times (p-value 0.006). Survival analysis showed that patients with positive blood cultures had a longer length of stay. Conclusion: Adequate knowledge of the microbiological profile and antimicrobial resistance by nurses is essential to guide the planning and implementation of care, managerial, and educational strategies for nursing and the entire multidisciplinary team.

References

Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Programa Nacional de Prevenção e Controle de Infecções Relacionadas à Assistência à Saúde (PNPCIRAS) 2021 a 2025. Brasília: Anvisa; 2021. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/pnpciras_2021_2025.pdf

World Health Organization. Health care without avoidable infections: The critical role of infection prevention and control. Geneva: OMS;2016. Disponível em: https://www.who.int/publications/i/item/WHO-HIS-SDS-2016.10

Hespanhol LAB, Ramos SCS, Ribeiro JOC, Araújo TS de, Martins AB. Infecção relacionada à Assistência à Saúde em Unidade de Terapia Intensiva Adulto. Enferm. glob. 2019;18(53):215-254. DOI: https://dx.doi.org/10.6018/eglobal.18.1.296481

Mathur P. Prevention of healthcare-associated infections in low- and middle-income Countries: The “bundle approach”. Indian J Med Microbiol, 2018;36:155-162. DOI: https://dx.doi.org/10.4103/ijmm.IJMM_18_152

Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet; 399(10325):P629-655. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0

Sociedade Brasileira de Microbiologia (SBM). A ameaça das superbactérias. Rev microb in foco. 2017;8(31):11-16. Disponível em: https://sbmicrobiologia.org.br/revista/a-ameaca-das-super-bacterias/

Leal HF, Azevedo J, Silva GEO, Amorim AML, Roma LGC, Arraes ACP, et al. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC infect dis. 2019;19(609). DOI: https://doi.org/10.1186/s12879-019-4265-z

World Health Organization. Antimicrobial Resistance. Geneva: WHO; 2021. Disponível em: https://www.who.int/health-topics/ antimicrobial-resistance

Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev saúde publ. 2010;44(3):559-565. DOI: https://doi.org/10.1590/S0034-89102010000300021

Schöneweck F, Schmitz RPH, Ribner F. et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study (AlertsNet). Antimicrob resist infect control. 2021;10(132). DOI: http://dx.doi.org/10.1186/s13756-021-00997-6

Liaquat S, Baccaglini L, Haynatzki G, Medcalf SJ, Rupp ME. Clinical consequences of contaminated blood cultures in adult hospitalized patients at an institution utilizing a rapid blood-culture identification system. Infect Control Hosp Epidemiol. 2021;42(8):978-984. DOI: http://dx.doi.org/10.1017/ice.2020.1337

Friedrich JV, Friedrich JM, Daronco A, Friedrich JL, Uhde SPR. Perfil de hemoculturas de pacientes internados em unidade de terapia intensiva em hospital de ensino do Paraná. Research, Society and Development. 2022;11(13):e132111335325. DOI: http://dx.doi.org/10.33448/rsd-v11i13.35325

Liu T, Wang J, Yuan Y. et al. Early warning of bloodstream infection in elderly patients with circulating microparticles. Ann. Intensive Care. 2021;11(110). DOI: https://doi.org/10.1186/s13613-021-00901-w

Laupland, KB, Pasquill, K., Steele, L. et al. Carga de infecção da corrente sanguínea em idosos: um estudo de base populacional. BMC geriatra. 2021;31. DOI: https://doi.org/10.1186/s12877-020-01984-z

Esme M, Topeli A, Yavuz BB and Akova M (2019) Infections in the Elderly Critically-Ill Patients. Front. med. 6:118. DOI: 10.3389/fmed.2019.00118

Tibúrcio AS. Economic costs of healthcare-related infections acquired in an Intensive Care Unit. J infect control. 2019;8(1):8-11.

Leal MA, Freitas-Vilela AA. Costs of healthcare-associated infections in an Intensive Care Unit. Rev bras enferm. 2021;74(1):e20200275. DOI: http://dx.doi.org/10.1590/0034-7167-2020-0275

Yang L, Lin Y, Wang J, et al. Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study. Infect Drug Resist. 2021;14:4.191-4.205. DOI:1 http://dx.doi.org/0.2147/IDR.S334161

Conway R, O'Connell B, Byrne D, O'Riordan D, Silke B. Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions. Acute med. 2020;19(2):83-89.

Garbuio DC, Baldavia NE, Silva RB, Lino A. Caracterização das infecções relacionadas à assistência à saúde em Unidade de Terapia Intensiva adulto. Rev epidemiol control infect. 2022;12(1). DOI: https://doi.org/10.17058/reci.v12i1.16471

Brasil. Ministério da Saúde; Agência Nacional de Vigilância Sanitária. Boletim Segurança do Paciente e Qualidade em Serviços de Saúde nº 23 – Avaliação dos Indicadores Nacionais de Infecções Relacionadas à Assistência à Saúde (Iras) e Resistência Microbiana (RM). Brasília: Anvisa; 2020.

Quillici MCB, Resende DS, Gonçalves IR, Royer S, Sabino SS, Almeida VF de, et al. Gram-negative bacilli bacteremia: a 7 year retrospective study in a referral Brazilian tertiary-care teaching hospital. Journal of medical microbiology. 2021;70(1). DOI https://doi.org/10.1099/jmm.0.001277

Naue CR, Leite MIM, Colombo A, Silva CF. Prevalência e perfil de sensibilidade antimicrobiana de bactérias isoladas de pacientes internados em Unidade de Terapia Intensiva de um hospital universitário do Sertão de Pernambuco. Semin. cienc. biol. saúde. 2021;42(1):15-28. DOI: https://doi.org/10.5433/1679-0367.2021v42n1p15

Mota FS, Oliveira HA, Souto RCF. Perfil e prevalência de resistência aos antimicrobianos de bactérias gram-negativas isoladas de pacientes de uma Unidade de Terapia Intensiva. RBAC. 2018;50(3):270-277.

Schechner V, Wulffhart L, Temkin E, Feldman SF, Nutman A, Shitrit P et al. One-year mortality and years of potential life lost following bloodstream infection among adults: A nation-wide population based study. The Lancet Regional Health - Europe. 2022;23 (100511). DOI: https://doi.org/10.1016/j.lanepe.2022.100511

Padoveze MC, Abraão LM, Figueiredo RM. Antimicrobials and Antimicrobial Resistance. In: Courtenay M, Castro-Sánchez E, editores. Antimicrobial stewardship for nursing practice. 1st ed. Londres: CABI; 2020,1:25-38. DOI: http://dx.doi.org/10.1079/9781789242690.0025

Abraão LM, Figueiredo RM, Gusmão VCL, Félix AM, Ciofi-Silva CL, Padoveze MC. Brazilian Nurses Network Tackling the Antimicrobial Resistance (REBRAN):bringing the role of nurses from the shadow to the light. Rev Esc Enferm USP. 2023;57:e20230367. DOI: https://doi.org/10.1590/1980-220X-REEUSP-2023-0367en

American Nurses Association – ANA. Centers for Disease Control – CDC. Redefining the antibiotic stewardship team: recommendations from the American nurses association/centers for disease control and prevention workgroup on the role of registered nurses in hospital antibiotic stewardship practices. Silver Springs, MD: ANA; 2017.

Monsees E, Lee B, Wirtz A, Goldman J. Implementation of a nurse-driven antibiotic engagement tool in 3 hospitals. Am J infect control. 2020;48(12):1.415-1.421. DOI: http://dx.doi.org/10.1016/j.ajic.2020.07.002

Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Prevenção de infecções por micro-organismos multirresistentes em serviços de saúde. Brasília: Anvisa; 2021.

Silva LOP, Nogueira JMR. Indiscriminate use of antibiotics during the pandemic: increasing in post-COVID-19 bacterial resistance. Rev. bras. anal. clin. 2021;53(2):185-186, 20210630.

Published

2024-05-06

How to Cite

Henrique, D. M., de Carvalho, A. M., Camerini, F. G., Fassarella, C. S., Leão, R. S., & de Almeida, L. F. (2024). Bacteriological profile analysis of patients admitted to intensive care regarding morbidity and mortality: A longitudinal study. Context and Health Journal, 24(48), e14017. https://doi.org/10.21527/2176-7114.2024.48.14017

Issue

Section

ORIGINAL ARTICLE