Culturas de vigilância em unidade de terapia intensiva adulto: incidência e fatores relacionados à positividade

Abstract

Infections by multidrug-resistant microorganisms (MDR) are one of the main causes of hospitalization of patients, and the most frequent complication in hospitalized patients, given their difficulty, limitation and, sometimes, impossibility of treatment (MARTINEZ-AGUERO et al., 2019). In order to isolate and identify pathogenic microorganisms using research and analysis methods, the monitoring of the occurrence of MDR microorganisms was created through the performance of surveillance cultures, which is a means of active surveillance where the microorganisms in interaction with men and classify them according to their profile (BRASIL, 2017). It aimed to verify the incidence of multidrug-resistant microorganisms and the factors associated with the positivity of surveillance cultures in an Adult Intensive Care Unit (ICU). This is a retrospective cross-sectional analytical study, carried out in the Adult Intensive Care Unit, aimed at treating adult patients with predominantly clinical demands in a university hospital, located in a capital in the Midwest region of the country, from January to December of 2018. 294 new patients were admitted to the Clinical Adult Intensive Care Unit of the aforementioned University Hospital in 2018. Of this sample, 63 patients were admitted and readmitted to the ICU throughout 2018, subtracted and computed only with reference to the first admission to the ICU. From this survey, it was possible to obtain the eligible population of 231 patients, among which, 84 (36.36%) were submitted to monitoring through surveillance cultures on admission. Of the 84 patients who underwent surveillance cultures, 35.71% had a positive culture result and 64.28% had a negative result. Klebsiella pneumoniae carbapenemase (KPC) was the microorganism with the highest incidence (26.60%), accompanied by extended-spectrum beta-lactamase (ESBL+) (20.00%), methicillin-resistant Sthaphylococcus aureus (MRSA) ( 16.60%), and Acinetobacter baumannii (10.00%). Regarding the origin of patients admitted to the ICU and submitted to monitoring of colonization by multi-resistant microorganisms through surveillance cultures, 36.90% came from Hospitals or Emergency Units in the capital, followed by inpatients from the hospital itself (33.33%), and medium and high complexity hospitals (29.76%) as shown in table 3. It is noteworthy that 11.90% of the medium and high complexity hospitals from which the patients in this study came, are located in the interior of the State of Goiás. Patients admitted to the ICU with an orotracheal tube or tracheostomy are about 4 times more likely to have a positive result in surveillance cultures (p=0.0182; OR=4.2373; CI=95%). Staying for more than five days of previous hospitalization at another institution was statistically significant (p=0.039) in relation to the incidence of positivity in surveillance cultures. It was concluded that the incidence and factors associated with the positivity of surveillance cultures in this study show the importance of these cultures being performed, as they have application in the detection of patients colonized by multiresistant microorganisms, even if they do not present clinical signs and symptoms of infection , and can thus contribute to the adoption and reinforcement of good practices aimed at the prevention of infections and patient safety