Estudo de colonização bacteriana em recem-nascidos e controle de bacterias multirresistentes em berçario de alto risco apos instituição de medidas de intervenção

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

The emergence of multiresistant bacteria infections m a neonatal unit during 1995, especially Enterobacter cloacae, stimulated this study. The aim of this study was to describe the bacterial colonization m newborns admitted in high risk nursery of CAISM/UNICAM identifying the multirresistant strain and the babies features. The specific purposes were to study the time occurence of colonization, to know the incidence and prevalence of multirresistant bacteria colonization, to evaluate the risk factors for multirresistant strain colonization and the efficacy of measures to control colonization and nosocomial infection by multirresistant in a neonatal unit of a university hospital. This study was conducted from October 1995 to December 1999 in four phases: a cross-sectional study; a longitudinal study with intervention measures; monthly cross-sectional studies and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant S. aureus and gram-negative bacteria resistant to either aminoglycosides and/or third generation cepbalosporins). Umbilical and rectal swabs were cultured at ages 24 hours, 72 hours, one week and weekly thereafter until hospital discharge. Cultures of tracheal aspirates were also obtained from intubated babies at the same periods. The intervention measures were: a) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization and the importance of rational usage of antibiotics; b) supression of third generation cepbalosporins usage. Risk factors were analyzed through univariate and multivariate logistic regression. In the first phase, 32% (l 0/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant Enterobacter cloacae). In the second phase, 342 patients were evaluated and it was collected for the colonization research , 896 umbilical swabs, 898 rectal swabs and 106 tracheal aspirates,with the respective positivity, 63.2%, 81.4% and 51.8%. No bacterium was isolated m 5.3% of the patients. The most frequent bacteria that colonized by the newborns were coagulase-negative Sthaphylococcus, Streptococcus sp, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae and Staphylococcus aureus. The gram negative bacterium colonization not considered of the "normal" flora (Enterobacter cloacae, Klebsiella pneumoniae) increased with the duration of hospitalization. Evaluating the bacterial resistance profile,the most frequent multiresistant bacterium was Enterobacter cloacae that was found m 10.8% (37/342) of the newborns. The monthly incidence of patients colonized by multirresistant E. cloacae,was 10% in November 1995, 15.6% in January 1996 and it decreased to 1.8% in April 1996. A logistic regression model of multivariate analysis indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant Enterobacter cloacae. In the third phase, for six-month period, only two patients were colonized by multiresistant Enterobacter cloacae. In the fourth phase, the analysis of bacterial resistance profile, indicated a reduction of nosocomial infections due to multiresistant bacteria from 18 cases in 1995 to two cases per year until 1999. These results have shown that the measures adopted were effective

ASSUNTO(S)

cefalosporinas recem-nascidos enterobacterias colonização

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