Pattern of infection and antibiotics in the intensive care unit
Introduction: The central theme of this study is infection, more specifically Helthcare Associated Infections (HAI), associated with the use of invasive devices, such as Endothraqueal Tube (ETT) and Mechanical Ventilation, Central Line (CL) and Urinary Catheter (UC), as well as the microorganisms involved and antimicrobials used, in the context of intensive care.
Intensive Care Units (ICU) are the units most likely for the occurrence of HAIs and resistance to antibiotics, and health professionals are confronted with the severity of the patients' clinical condition and their susceptibility to the acquisition of HAIs.
It is essential to reduce the use of invasive devices to prevent infection and minimize cross-transmission. The problem of resistance to antimicrobials is higher in ICUs, mostly associated with the severity of the patients' clinical situation, the frequent use of antibiotics and the heterogeneity in the implementation of HAIS prevention and control measures.
Objetives: This study aims to:
- Identify HAIS related to invasive devices (ETT, CL and UC) acquired at UCIP;
- Calculate the Incidence Rates and Incidence Density of HAIS related to the use of ETT, CL and UC, at UCIP;
- Calculate Exposure Rates to ETT, CL and UC invasive devices, at UCIP;
- Describe the type of microorganisms existing in the ICU;
- Identify the most prescribed antimicrobials in the ICU.
Methods: The study designed for this investigation includes the methods of quantitative analysis; falls within the type of non-experimental research; it is a descriptive and analytical study because it aims to analyze essentially the risk factors for HAIs extrinsic to the patient, such as the time of exposure to invasive devices, such as ETT and Mechanical Ventilation, CL and UC, but it also analyzes the previous situation of critically ill patients before admission to the ICU, regarding the days of hospitalization and submission to antibiotics. It also intends to identify which are the main microorganisms responsible for the HAIs acquired in the ICU and the antibiotics used, believing that it is in these factors that changing practices can reduce the incidence of this type of infection.
This study includes patients admitted to a ICU, which belongs to a Hospital Center in Portugal, undergoing mechanical ventilation for a period greater than or equal to 48 hours, with three or more days of hospitalization in this unit. Retrospectively, the clinical records corresponding to a period of 6 months between, 1 July to 31 December, from the years 2010, 2011 and 2012 were analyzed. The choice of this period was in an attempt to search for similar samples, supported in the similarity of the type of patients admitted at the time of the years under study.
In the ICU, during the study period, 26 patients (16%) developed HAI during hospitalization, with a decrease in these values over the three years.
Results: One of the main results of this study is that Ventilator Associated Pneumonia (VAP) was the most incident, affecting 18 patients (69.2%) of the 26 who acquired HAIS; in the background are bloodstream infection associated with CL and urinary tract infection associated with the urinary catheter, both with 15.4% incidence rate. It was found that the CV was the device with the highest exposure rates (0.98), ETT with 0.81 and the CL being the device with the lowest rates (0.79). As for the microorganisms responsible for the HAIs diagnosed in this study, they were mostly Staphylococcus aureus Meticilino-Resistant (45.8%), Escherichia coli (12.4%), and Aerobinous enterobacter (8.4%). Regarding the microorganisms responsible for VAP isolated in this study, the one that appears in greater number in the three years is the methicillin-resistant Staphylococcus aureus (50%), followed by Escherichia coli (12.4%) and pseudomonas aeruginosa (6.2%). In 96.2% of the HAI cases, antibiotic therapy was instituted, mostly as empirical antibiotic therapy (65.2%), showing that only 34.8% corresponded to antibiotics directed to the causative agent. Most patients admitted to the ICU (86.5%) in the three years were submitted to antibiotics prior to admission to this unit, and in most cases (84.8%) empirically.
Conclusions: This study demonstrates that the most prevalent HAI in the ICU is PAV, the isolated infectious agent in most cases was Meticilino-Resistant Staphylococcus aureus, and antibiotics instituted was mostly empirical. Patients' exposure to invasive devices is significant, with high UC, ETT and CL exposure rates.
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