Navegando por Assunto "Mortalidade neonatal"

Agora exibindo 1 - 1 de 1

Acesso aberto (Open Access)
Epidemiologia das infecções de corrente sanguínea por enterobactérias produtoras de betalactamase de espectro expandido: estudo caso-controle em Unidade Neonatal do Norte do Brasil
(Universidade Federal do Pará, 2012) SILVA, Danille Lima da; CARNEIRO, Irna Carla do Rosário Souza; http://lattes.cnpq.br/4389330944043163
Gram-negative bacilli, especially Enterobacteriacea, are frequently associated with neonatal sepsis. A retrospective case-control study was performed to study bloodstream infections (BSI) caused by extended-spectrum beta-lactamase-producing (ESBL) enterobacteria in a neonatal unit the northern region of Brazil. This research was undertaken of all neonates admitted between 1st January 2007 and 31st December 2011 to the neonatal care unit, who had late-onset sepsis with blood cultures positive for Klebsiella sp., Enterobacter sp., Serratia sp. and Escherichia coli, performed according to National Committee for Clinical Laboratory Standards criteria. There were 153 neonates with gram-negative septicaemia, 87 newborns were infected with ESBL-producing enterobacteria, with incidence of 8.63 cases per 1000 newborns admitted. These were studied 132 patients, divided in two groups, cases (ESBL +) and controls (ESBL -), of 66 each (1:1). Most cases were affected in the first days of life (34,8% vs. 9,1%, p=0,001), especially in 2007 (19,7%), and made use two antibiotics (59,1% vs. 33,3%, p=0,01). The control group made more use of central venous catheter (62,1% vs. 45,4%, p=0,037) and parenteral nutrition (75,7% vs. 48,5%, p=0,001). The distribution curve of enterobacteria in accordance with the production of ESBL throughout the study period showed a greater number of cases in 2007 and 2008 (56,05%), with a higher chance of acquiring ESBL-producing enterobacteria these years (78% e 72%, respectively), and a higher number of controls for 2010 and 2011 (72,7%). The evolution to more deaths occurred among the cases (40,9% vs. 24,2%, p=0,031) and the majority died within 30 days of the episode of ICS (92,6% vs. 50,0%, p=0,002). In multivariate analysis, the evolution to death by ESBL-producing remained as an independent variable (OR=3,47 IC 1,33 – 9,06). It was concluded that there was a higher incidence of ESBL-producing enterobacteria BSI for the first two years of the study (2007 - 2008), with probability of acquiring this type of infection of up to 78%. The neonatal mortality was high, being three times greater when compared to infections by non-ESBL-producing enterobacteria. The change of the resistance profile of BSI by enterobacteria, reducing the number of cases of ESBL over time was a result of the implementation of control measures for dissemination and selection of bacterial resistance in the neonatal unit, and coinciding with the revision of care protocols as increased use of PICC and parenteral nutrition protocol in the period from 2010 to 2011.