Impacto das ações de prevenção de infecção hospitalar na mudança do perfil microbiológico institucional, sepse e mortalidade neonatal

Abstract

Healthcare-associated infections are acquired in healthcare services when an infectious agent affects a susceptible host, causing disease. In the neonatal intensive care unit, primary bloodstream infections associated with central venous catheters are recognized as the most common among reported infections. This study aims to evaluate the impact of infection prevention and control measures on changes in the institutional microbiological profile and neonatal mortality. It is a descriptive, retrospective, and quantitative study conducted in the neonatal intensive care unit of a maternity hospital in Fortaleza, Ceará, Brazil. The study included newborns with positive blood culture results for laboratory-confirmed primary bloodstream infections and/or deaths due to hospital-acquired infections between 2016 and 2023. Data collection was carried out using a structured instrument based on infection monitoring records completed by the hospital infection control service. The data were presented in tables and graphs, providing information on the microbiological profile, the incidence density of laboratory-confirmed primary bloodstream infections, and the prevalence of neonatal deaths due to hospital-acquired infections. Between 2016 and 2017, the prevalence of gram-positive microorganisms increased from 27% to 44%, and gram- negative microorganisms increased from 44% to 48%. During the same period, positive blood cultures for fungi decreased by more than 80%, from 24% to 3%. Between 2017 and 2018, the bacterial flora in blood cultures became predominantly composed of gram-positive microorganisms. The incidence density of laboratory- confirmed primary bloodstream infections in newborns dropped from 8‰ in 2016 to 6‰ in 2017-2018, reaching 4‰ in 2019 and remaining stable until 2021. In 2022 and 2023, the incidence density increased to 5‰ and 6‰, respectively. Neonatal mortality due to hospital-acquired infections decreased from 28% in 2016 to 14% in 2019, reaching 7% in 2023. These interventions contributed to changes in the microbiological profile of infections, with a reduction in the prevalence of gram-negative microorganisms associated with higher morbidity and mortality. Additionally, there was a decrease in the incidence density of primary bloodstream infections and a reduction in neonatal mortality due to hospital-acquired infections.