Determinants of late neonatal nosocomial infection: a case-control study in Ceará
DOI:
https://doi.org/10.11606/s1518-8787.2022056003291Keywords:
Infant, Newborn, Infant, Premature, Cross Infection, epidemiology, rug Resistance, Multiple, Bacterial, Risk Factors, Case-Control StudiesAbstract
OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56–0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30–0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84–35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12–5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26–9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54–7.69); central venous catheters (OR = 10.00; 95%CI: 6.66–16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02–5.12); surgery (OR = 4.00; 95%CI: 2.27–7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83–17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26–2.68); central venous catheters (OR = 2.48; 95%CI: 1.40–4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.
References
Organização Pan-Americana da Saúde, Centro Latino-Americano de Perinatologia, Saúde da Mulher e Reprodutiva. Prevenção de infecções relacionadas à assistência à saúde em neonatologia. Montevidéu (UY): OPAS; CLAP; 2016. (CLAP/SMR Publicação Científica; 1613-03).
Ferreira AM, Barcelos LS, Rigotti MA, Andrade D, Andreotti JT, Almeida MG. Superfícies do ambiente hospitalar: um possível reservatório de micro-organismos subestimado? Revisão integrativa. Rev Enferm UFPE. 2013;7(5 nº espec):1549-60. https://doi.org/10.5205/reuol.4134-32743-1-SM-1.0705esp201310
Paula AO, Salge AKM, Palos MAP. Infecciones relacionadas a la asistencia de la salud en unidades de terapia intensiva neonatal: una revisión integradora. Enferm Glob. 2017;(45):508-22. https://doi.org/10.6018/eglobal.16.1.238041
Agência Nacional de Vigilância Sanitária, Gerência de Vigilância e Monitoramento em Serviços de Saúde, Gerência Geral de Tecnologia em Serviços de Saúde. Critérios diagnósticos de infecção relacionada à Assistência à Saúde – Neonatologia. Brasília, DF: Anvisa; 2017. (Caderno 3).
Baptista AB, Ramos JMM, Neves RR, Souza DF, Pimenta RS. Diversity of environmental and patients bacteria in the Hospital Geral de Palmas-TO. J Bioenergy Food Sci. 2015;2(4):160-4. https://doi.org/10.18067/jbfs.v2i4.63
Távora ACVCF, Castro AB, Militão MAM, Girão JE, Ribeiro KCB, Távora LGF. Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit. Braz J Infect Dis. 2008;12(1):75-9. https://doi.org/10.1590/S1413-86702008000100016
Kim JK, Chang YS, Sung S, Ahn SY, Park WS. Trends in the incidence and associated factors of late-onset sepsis associated with improved survival in extremely preterm infants born at 23-26 weeks’ gestation: a retrospective study. BMC Pediatr. 2018;18(1):172. https://doi.org/10.1186/s12887-018-1130-y
Ponce CF, Madrid WA, Pineda IJ. Agentes bacterianos en la sepsis neonatal. Cuidados Intensivos Neonatales Hospital Mario Catarino Rivas. Acta Pediatr Hondur. 2017;6(2):479-85. https://doi.org/10.5377/pediatrica.v6i2.3538
United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels and trends in child mortality: report 2017, estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2017.
Feil AC, Kurtz T, Abreu PDO, Zanotto JC, Selbach LS, Bianchi MF, et al. Sepse tardia em Unidade de Tratamento Intensivo Neonatal. Rev Epidemiol Control Infecç. 2018;8(4):4506. https://doi.org/10.17058/reci.v8i4.11581
Restrepo JL, Ospina ICM, Jaramillo FLO. Factores de riesgo asociados a infecciones por bacterias multirresistentes derivadas de la atención en salud en una institución hospitalaria de la ciudad de Medellín 2011-2014. Infectio. 2016;20(2):77-83. https://doi.org/10.1016/j.infect.2015.09.002
França E, Lansky S. Mortalidade infantil neonatal no Brasil: situação, tendências e perspectivas. In: Anais do 16. Encontro Nacional de Estudos Populacionais; 29 set – 3 out 2008; Caxambu, MG. Belo Horizonte, MG: Associação Brasileira de Estudos Populacionais; 2008. p.1-29.
Lima CSSC. Fatores de risco para óbito infantil em Unidade de Terapia Intensiva Neonatal do Estado do Ceará: estudo caso-controle [dissertação]. Fortaleza, CE: Universidade de Fortaleza - UNIFOR; 2011.
Medeiros FVA, Alves VH, Valete COS, Paiva ED, Rodrigues DP. A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal. Acta Paul Enferm. 2016;29(5):573-81. https://doi.org/10.1590/1982-0194201600079
Silva SMR, Motta GCP, Nunes CR, Schardosim JM, Cunha MLC. Sepse neonatal tardia em recém-nascidos pré-termo com peso ao nascer inferior a 1.500g. Rev Gaucha Enferm. 2015;36(4):84-9. https://doi.org/10.1590/1983-1447.2015.04.50892
Dal-Bó K, Silva RM, Sakae TM. Infecção hospitalar em uma unidade de terapia intensiva neonatal do Sul do Brasil. Rev Bras Ter Intensiva. 2012;24(4):381-5. https://doi.org/10.1590/S0103-507X2012000400015
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365(9462):891-900. https://doi.org/10.1016/S0140-6736(05)71048-5
Alves JB, Gabani FL, Ferrari RAP, Tacla MTGM, Linck Júnior A. Neonatal sepsis: mortality in a municipality in Southern Brazil, 2000 to 2013. Rev Paul Pediatr. 2018;36(2):132-40. https://doi.org/10.1590/1984-0462/;2018;36;2;00001
Nunes BM, Xavier TC, Martins RR. Problemas relacionados a medicamentos antimicrobianos em unidade de terapia intensiva neonatal. Rev Bras Ter Intensiva. 2017;29(3):331-6. https://doi.org/ 10.5935/0103-507X.20170040
Pina E, Ferreira E, Marques A, Matos B. Infecções associadas aos cuidados de saúde e segurança do doente. Rev Port Saude Publica. 2010;(10):27-39.
Tragante CR, Ceccon MEJR, Falcão MC, Seiti M, Sakita N, Vieira RA. Prevalência de sepse por bactérias Gram negativas produtoras de beta-lactamase de espectro estendido em Unidade de Cuidados Intensivos Neonatal. Rev Paul Pediatr. 2008;26(1):59-63. https://doi.org/10.1590/s0103-05822008000100010
Lopes GK, Rossetto EG, Belei RA, Capobiango JD, Matsuo T. Estudo epidemiológico das infecções neonatais no Hospital Universitário de Londrina, Estado do Paraná. Acta Sci Health Sci. 2008;30(1):55-63. https://doi.org/10.4025/actascihealthsci.v30i1.4386
Rangelova V, Kevorkyan A, Krasteva M. Nosocomial infections in the neonatal intensive care unit. Arch Balk Med Union. 2020;55(1):121-7. https:/doi.org/10.31688/ABMU.2020.55.1.14
Dhaneria M, Jain S, Singh P, Mathur A, Lundborg C, Pathak A. Incidence and determinants of health care-associated blood stream infection at a neonatal intensive care unit in Ujjain, India: a prospective cohort study. Diseases. 2018;6(1):14. https://doi.org/10.3390/diseases6010014
Su BH, Hsieh HY, Chiu HY, Lin HC, Lin HC. Nosocomial infection in a neonatal intensive care unit: a prospective study in Taiwan. Am J Infect Control. 2007;35(3):190-5. https://doi.org/10.1016/j.ajic.2006.07.004
Ertugrul S, Aktar F, Yolbas I, Yilmaz A, Elbey B, Yildirim A, et al. Risk factors for health care-associated bloodstream infections in a neonatal intensive care unit. Iran J Pediatr. 2016;26(5):e5213. https://doi.org/10.5812/ijp.5213
Yusef D, Shalakhti T, Awad S, Algharaibeh H, Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review. Pediatr Neonatol. 2018;59(1):35-41. https://doi.org/10.1016/j.pedneo.2017.06.001
Sociedade Brasileira de Pediatria. Consenso Brasileiro em Ventilação Mecânica. Suporte ventilatório na síndrome do desconforto respiratório do recém-nascido. Miyoshi MH, relator. São Paulo; 2015 [citado 15 out 2020]. Disponível em: https://www.sbp.com.br/fileadmin/user_upload/2015/02/SDR.pdf
Wang L, Du KN, Zhao YL, Yu YJ, Sun L, Jiang HB. Risk factors of nosocomial infection for infants in neonatal intensive care units: a systematic review and meta-analysis. Med Sci Monit. 2019;25:8213-20. https://doi.org/10.12659/MSM.917185
Agência Nacional de Vigilância Sanitária, Gerência de Vigilância e Monitoramento em Serviços de Saúde, Gerência Geral de Tecnologia em Serviços de Saúde. Critérios diagnósticos das infecções relacionadas à Assistência à Saúde. Brasília, DF: Anvisa; 2019 [citado 15 out 2020]. (Nota Técnica GVIMS/GGTES; nº 3). Disponível em: https://ameci.org.br/wp-content/uploads/2019/02/nota-tecnica03-2019-GVIMS-GGTES-anvisa.pdf
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Carmen Sulinete Suliano da Costa Lima, Hermano Alexandre Lima Rocha, David Augusto Batista Sá Araújo, Cláudia Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
Funding data
-
Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico
Grant numbers Edital Jovens Doutores - nº 02/2017
