Bacteremia causada por enterobactérias do grupo mspace: avaliação da adequação a antibioticoterapia e desfechos clínicos em pacientes críticos em um hospital universitário em São Paulo

• Ano de defesa: 2016
• Autor(a) principal: Sakata, Renata Akemi Prieto [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Enterobacterias grupo mspace; Bacteremia; Antibioticoterapia; Simulação de monte carlo
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3666961; http://repositorio.unifesp.br/handle/11600/48412

Objective: To analyze antibiotic therapy, mortality and clinical outcome of patients with bloodstream infections (BSI) caused by MSPACE Enterobacteriaceae at Hospital São Paulo from January 2010 to December 2013. Method: An observational retrospective cohort study was performed. Patients with positive blood cultures with: Morganella morganii, Serratia spp., Providencia spp., Citrobacter spp., and Enterobacter spp. The enterobacter Yersinia spp. and Aeromonas spp. will not be the focus of this study because of the low incidence in hospital. It was evaluated antimicrobial therapy with regard to clinical outcome, 15-day mortality and 30-day mortality rates. Monte Carlo Simulation was used for the selection of optimal antibiotic regimens for the treatment of those infections. Results: Overall, 102 bacterial isolates, including Citrobacter spp, Enterobacter spp e Serratia marcescens were analyzed. Enterobacteria Yersinia spp. and Aeromonas spp. will not be the focus of this study because of the low incidence in the hospital. According to the site of origin of bacteremia, respiratory tract infection was the most frequent infection (31, 30.4%). Eighty-two patients (80%) received appropriate empirical therapy. Eighty-one patients (86.1%) received appropriate targeted therapy, prevailing monotherapy (69, 73,4%). The most commonly used appropriate targeted therapy was meropenem (25, 36,2%). The 15-day and 30-day mortality rates were 2.9% and 3.9%, respectively. In the multivariate analysis, age was the sole predictor of mortality (OR: 1.23; 95% CI: 1.02 to 1.48; P = 0.02). There were no predictors of 30-day mortality. Piperacillin / tazobactam, meropenem and imipenem achieved an ideal therapeutic target (?90%) for all the Enterobacteriaceae analyzed. Cefepime achieved ideal Citrobacter spp and Enterobacter aerogenes. Ciprofloxacin did not reached ideal therapeutic target for any isolated. Conclusion: Bloodstream infection caused by MSPACE Enterobacteriaceae a low mortality rates regardless of the appropriateness of antimicrobial therapy. Monotherapy was the most used. High dose and prolonged infusion reached an ideal pharmacodynamic target against Citrobacter spp and Enterobacteraerogenes.