Bacteremia por Staphylococcus epidermidis em neonatos: incidência e fatores de risco
Palavras-chave:
Bacteremia, Fatores de risco, Recém-nascido, Staphylococcus epidermidisResumo
Objetivo
Avaliar a incidência de bacteremia por Staphylococcus epidermidis e sua associação com o baixo peso, com o uso de cateter vascular central e com o escore de gravidade (Score for Neonatal Acute Physiology) em uma Unidade de Terapia Intensiva Neonatal de um hospital universitário brasileiro.
Métodos
Foi realizado um estudo caso-controle na Unidade de Terapia Intensiva Neonatal, utilizando-se a vigilância National Nosocomial lnfection System, no período entre
janeiro de 2004 e dezembro de 2005. Uma ficha individual foi preenchida, contendo dados demográficos, clínicos e epidemiológicos. As culturas de sangue positivas para 5taphy/ococcus coagulase-negativa foram identificadas nas respectivas espécies.
Resultados
A taxa de incidência de infecção hospitalar, definida por critérios microbiológicos, foi de 19,7 %, sendo estas infecções representadas, em sua maioria, por episódios de sepse (88,8%) Os 5taphy/ococcus coagulase-negativa responderam por 68,8% dessas bacteremias, representados por 5. epidermidis (97,7%) e 5. haemolyticus (2,3%). O baixo peso (,;;1.500g), o uso de cateter vascular central inserido por flebotomia e o valor de escore de gravidade maior ou igual a 20 foram fatores de risco estatisticamente significantes (p,s"0,05) para infecção por 5. epidermidis. As taxas de infecção por 5. epidermidis relacionadas ao uso de cateter vascular central e a densidade de incidência/1 000 dias de uso deste foram de 18,2 % e 37,2%0 para flebotomia; 6,6% e 19,8%0 para intracath; 4,3% e 10,2%0 para cateter central de inserção periférica; 2,5% e 5,5%0 para umbilical, respectivamente.
Conclusão
Os 5taphylococcus coagulase-negativa são responsáveis pela maioria dos episódios de sepse na Unidade de Terapia Intensiva Neonatal, representados quase que exclusivamente por 5. epidermidis. Os fatores de risco: peso menor ou igual a 1 500g, uso de cateter vascular central inserido por flebotomia e valores de escore de gravidade maiores ou iguais a 20 foram associados a estas infecções.
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Referências
Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, et ai. Coagulase negative staphylococcal sepsis in neonates: association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr lnfect Dis J. 2005; 24(4):817-22.
lsaacs D. A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units. Arch Dis Child Fetal Neonatal. 2003; 88(2):89-3.
Sarkar S, Bhagat 1, DeCristofaro JD, Wiswell TE, Spitzer AR. A study of the role of multipie site blood cultures in the evaluation of neonatal sepsis. J Perinatol. 2006; 26(1):18-22.
Michelim L, Lahude M, Araújo PR, Giovanaz DSH, Müller G, Delamare APL, et ai. Pathogenicity factors and antimicrobial resistance of Staphylococcus epidermidis associated with nosocomial infections occurring in intensive care units. Braz J Microbial. 2005; 36(1):17-23.
Miragaia M, Couto 1, Pereira SFF, Kristinsson KG, Westh H, Jarlov JO, et ai. Molecular characterization of meth ici11 in-resistant Staphylococcus epidermidis clones: evidence of geografic dissemination. J Clin Microbial. 2002; 35:430-8.
Pessoa-Silva CL, Ricchtmann R, Calil R, Santos RMR, Costa MLM, Frota ACC, et ai. Healthcare-associated infections among neonates in Brazil. lnfect Control Hosp Epidemiai. 2004; 25(9):772-7.
Bang AT, Bang RA, Stoll BJ, Baitule SB, Reddy HM, Deshmukh MD. Is home-based diagnosis and treatment of neonatal sepsis feasible and effective? Seven years of intervention in the Gadchiroli field triai (1996 to 2003) J Perinatol. 2005; 25:S62-S71.
Macias AE, Munoz JM, Galvan A, Gonzalez JA, Medina H, Alpuche C, et ai. Nosocomial bacteremia in neonates related to poor standards of care. Pediatr lnfect Dis J. 2005; 24(4):713-6.
Chien L, MacNab Y, Aziz A, Andrews W, McMillan DD, Lee SK. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr lnfect Dis J. 2002; 21(6):505-11.
Zardo MS, Procianoy RS. Comparison between different mortality risk scores in a neonatal intensive care unit. Rev Saúde Pública. 2003; 37(4):591-6.
Gray JE, Richardson DK, McCormick MC, Goldmann DA. Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatrics. 1995; 95(3) 225-9.
Zwet WC, Kaiser AM, Elburg RM, Berkhof J, Fetter WPF, Parlevliet GA, et ai. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp lnfect. 2005; 61(3):300-11.
Kloss WE, Bannerman TL. Staphylococcus and Micrococcus. ln: Murray PR, Barron EJ, Pfaller MA, Tenover FC, Yolken RH, editores. Manual of clinicai microbiology. 7th ed. Washington (DC): ASM Press; 1999. p.264-82.
Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005; 365(9): 1175-88.
Kawagoe JY, Segre CAM, Pereira CR, Cardoso MFS, Silva CV, Fukushima JT. Risk factors for nosocomial infections in critically ili newborns: a 5-year prospective cohort study. Am J lnfect Contrai. 2001; 29(2):109-14.
Nunes APF, Teixeira LM, Bastos CCR, Silva MG, Ferreira RBR, Fonseca LS, et ai. Genomic characterization of oxacillin-resistant Staphylococcus epidermidis and Staphy/ococcus haemolyticus isolated from Brazilian medical centres. J Hosp lnfect. 2005; 59(1):19-26.
Krediet TG, Mascini EM, Rooij E, Vlooswijk J, Paauw A, Gerards LJ, et ai. Molecular epidemiology of coagulase-negative staphylococci causing sepsis in a neonatal intensive care unit over an 11 year period. J Clin Microbial. 2004; 42(3):992-5.
Stool BJ, Hansen N, Fanaroff AA, Wright LL. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Netwok. Pediatrics. 2002; 110(2):285-91.
Kloss WE, Bannerman TL. Update on clinicai significance of Coagulase-Negative staphylococci. Clin Microbial Rev. 1994; 7(5):117-40.
Eshali H, Ringertz S, Nystrom S, Faxelius, G. Septicaemia with coagulase negative staphylococci in a neonatal intensive care unit. Acta Paediatr Scand. 1989; 360(3):127-34
Cunha MLRS, Lopes CAM, Rugolo LMSS, Chalita VAS. Clinicai significance of coagulase-negative staphylococci isolated from neonates. J Pediatr. 2002; 78(4):279-88.
Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney REJr, Cotton M, et ai. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics. 2001; 107(8):1272-6.
Baltimore RS. Neonatal nosocomial infections. Semin Perinatol. 1998; 22(1):25-32.
Ho JJ. Late onset infection in very low birth weight infants in Malaysian levei 3 neonatal nurseries. Pediatr lnfect Dis J. 2001; 20(3):557-60.
Klein MD, Rood K, Graham P. Central venous catheter sepsis in surgical newborns. Pediatr Surg lnt. 2003; 19(7) 529-32.
Trotter CW. A national survey of percutaneous central venous catheter practices in neonates. Neonatal Netw. 1998; 17(1):31-8.
Vergunta RK, Loethen P, Wallace LJ, Albert VL, Pearl RH. Differences in the outcome of surgically placed long-term central venous catheters in neonates: neck vs groin placement. J Pediatr Surg. 2005; 40(1):47- 51.
Hogan L, Pulito AR. Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia. J Pediatr Surg. 1992; 27(5):1185-8.
Thuong M, Arvaniti K, Ruimy R, Salmoniere P, Scanvic Ha meg A, Lucet JC, et ai. Epidemiology of Pseudomonas aeruginosa and risk factors for carriage acquisition in an intensive care unit. J Hosp lnfect. 2003; 53(4):274-82.
