Infecções de sítio cirúrgico após cirurgias cardíacas em um hospital universitário mineiro: incidência, aspectos microbiológicos e epidemiológicos
AUTOR(ES)
Marcília Batista de Amorim Finzi
DATA DE PUBLICAÇÃO
2010
RESUMO
Surgical site infections (SSI) after cardiac surgery is a significant problem for patients operated in terms of morbidity, mortality and costs. The objective of this study was to investigate epidemiological aspects of these infections in the main types of heart surgeries, including incidence, etiology, pathogenesis and risk factors of nosocomial infection, divided into ISC and other anatomical sites and hospital mortality in adult patients. We conducted a study case vs. control in patients undergoing cardiac surgery between November 2005 and August 2009. The most common surgical procedure was coronary artery bypass grafting (CABG) (53%), followed by surgery to repair valve (CRV) (25.2%), other surgeries (14.7%) and surgery combined CRM and CRV (6.9%). The rate of surgical site infection was 17.6%, with almost two thirds of patients diagnosed before hospital discharge. The ISC site infections were detected in 65 (14.5%) patients and organ/space in 10 patients (2.2%). The following independent risk factors were associated with the development of CSI: Body Mass Index (BMI) ≥ 30 kg/m2 (OR: 2.20, 95% CI 1.16 to 4.16, P = 0.0154), Risk index for surgical site infection "2" (IRIC) (OR: 1.81, 95% CI 1.00 to 3.29, P = 0.0506), CABG (OR: 2.36; 95% CI 1.22 to 4.58, P = 0.0109), postoperative hospitalization greater than 7 (seven) days (OR: 3.60, 95% CI 1.70 to 7.66, P = 0,0008). The nasal colonization prior patient with S. aureus, was also a predisposing factor (13.7% vs. 0% in the control group, P = 0.0011) only when the analysis. The rate of nosocomial infection episodes observed in other sites including the blood stream (CS) and urinary tract infection (UTI) and lungs (pneumonia), considered as a group exceeded (68.6%) of the ISC (31.3% ) with a ratio of 2.1 for each ISC These infections in other anatomical sites presented as independent risk factors for co-morbidity renal failure (OR: 3.55, 95% CI 2.00 to 6.32, P = <0.0001) and postoperative hospitalization longer than 7 (seven) days (OR: 5.76, 95% CI 2.93 to 11.33, P<0.0001). Microbiological criteria were used in the diagnosis of the majority of SSI (52.0%) and other IHS (59.0%), highlighting a predominance of gram-negative bacilli (GNB) (63.5%), absent in the air the operating room, Klebsiella spp. (24.1%) and Staphylococcus aureus (20.6%) as the most common pathogens. Microorganisms multidrug resistant (66.3%) predominated among the isolates recovered from clinical specimens. Mortality was significant both in patients with SSI (OR: 3.09, 95% CI 1.26 to 7.59, P<0.0134) and in those with severe infections like PNM and infections of CS (P<0, 05). Although the ISC, which are common in hospital practice, are increasingly recognized as a measure of quality of care offered to patients, more significant results in terms of morbidity, mortality, and therefore costs, especially when the inclusion of infections in other anatomical sites after cardiac surgery, as observed in this study, should be examined critically.
ASSUNTO(S)
fatores de risco cardiac surgery cirurgias cardíacas risk factors mortalidade hospitalar infecções hospitalares imunologia aplicada nosocomial infections hospital mortality
ACESSO AO ARTIGO
http://www.bdtd.ufu.br//tde_busca/arquivo.php?codArquivo=2860Documentos Relacionados
- Infecções ortopédicas em pacientes submetidos a artroplastias total de quadril e joelho, hemiartroplastias e osteossínteses: incidência, fatores de risco e influência do ar do Centro Cirúrgico em um Hospital Universitário Brasileiro
- Infecção do sítio cirúrgico em pacientes adultos submetidos a cirurgias limpas e contaminadas em hospital universitário brasileiro
- Vigilância pós-alta das infecções de sítio cirúrgico em crianças e adolescentes em um hospital universitário de Belo Horizonte, Minas Gerais, Brasil
- Incidência e fatores de risco para infecção de sítio cirúrgico em cirurgias gerais
- Evolução e viabilização de um centro cirúrgico ambulatorial para cirurgias de catarata em larga escala em um hospital universitário