Prevalência de infecções microbianas nas unidades de terapia intensiva neonatal de dois hospitais de referência da região norte do ceará

Abstract

The diverse infections associated to the health sphere present in neonatal intensive care units (NICUs) are the main causes of morbidity and mortality in these sectors, affecting the cost of medical assistance, due to increased duration of stay together with the use of resources. Additionally, another factor which has contributed for the development of antibiotic resistance, is selective pressure, resulting from the inadequate use of antimicrobial agents, especially in ICUs. The objective of the present research is to evaluate prevalence of microbial infections in Neonatal ICUs of two reference hospitals in the Northern Region of Ceará. The data collection was carried out in the neonatal ICUs 1 and 2 of the Santa Casa de Misericórdia de Sobral and the neonatal ICU of the Hospital Regional Norte (HRN). In this study, were included newborns with some nosocomial microbial infection in the period from January 2014 to April 2018 in the Hospital Regional Norte, and in the period from January 2016 to April 2018 in Santa Casa. The positive culture reports from the automated Vitek 2 ® (bioMérieux) system were collected for the patients of the nursery ICUs in Santa Casa, while for the HRN were collected the microbiological culture reports delivered by the BD ® (Becton Dickinson) system. Furthermore, the medical records of the patients were analysed for correlating age, sex, comorbidities and other factors to neonates with infections leading to death. The clinical data was submitted to Fischer's exact test or Pearson's chi-square test and the variables with significant association to death were analysed with a multinomial logistic regression model. A total of 79 nosocomial infections in the HRN, and 85 in Santa Casa, were laboratory confirmed. The most prevalent micro-organisms were S. epidermidis followed by K. pneumonia. The period of hospitalization being less than 30 days, the use of mechanical ventilation, and the lack of utilization of oxygen tents were risk factors for death. The isolated microorganisms were resistant to antimicrobials utilized in the clinic. The results of this study reinforce and warn the importance of preventing and treating in appropriate manner the dissemination of pathogenic micro-organisms in the neonatal ICUs, lessening the mortality rates and microbial resistance.