Pneumonia associada à ventilação mecânica (PAV) por Pseudomonas aeruginosa em Unidade de Terapia Intensiva (UTI): aspectos epidemiológicos e moleculares de amostras produtoras de metalo-β-lactamases

• Ano de defesa: 2010
• Autor(a) principal: Rodrigues, Dayane Otero
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Uberlândia; BR; Programa de Pós-graduação em Imunologia e Parasitologia Aplicadas; Ciências Biológicas; UFU
• Palavras-chave em Português: Pneumonia associada à ventilação mecânica; Pseudomonas aeruginosa; Metalo-β -lactamase; Resistência aos antibióticos; Fatores de risco; CNPQ::CIENCIAS BIOLOGICAS::IMUNOLOGIA::IMUNOLOGIA APLICADA
• Link de acesso: https://repositorio.ufu.br/handle/123456789/16560

The incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa producing metallo-β-lactamase is increasing, especially in critically ill patients. The objective of this study was to evaluate the incidence of ventilator associated-pneumonia (VAP) caused by P.aeruginosa producing metallo-β-lactamase (MBL-PA) or non-MBL-PA in patients admitted at a adult intensive care unit (ICU) of a Uberlândia Federal University Hospital Clinic, looking epidemiologic and molecular aspects. A cohort study was performed including 93 patients with VAP caused by P.aeruginosa from January/2004 to November/2006. The collection of the tract respiratory superior secretions was made by the swab-rinse sampling method and of the endotracheal aspirate when for suspicion of VAP. In total, 40 (43%) patients had VAP by MBL-PA and 53 (57%) by non-MBL-PA. The study was approved by the Ethical Committee of the University. The results of univariate analysis of risk factors for MBL-PA VAP showed that the ASIS score, clinical condition in admission, prior hospitalization, prolonged stay in the ICU, prolonged time of mechanical ventilation, exposure of carbapenems, fluorquinolones and use of three or more antibiotics were risk factors for VAP by MBL-PA. After logistic regression the following risk factors continued significant: prior hospitalization and prolonged time of mechanical ventilation. Additionally, the mortality was also independently associated with MBL-PA VAP. During the study period we identified 40 (43%) isolates of P.aeruginosa presumptive MBL producers according to the disk approximation tests and of the 59% of the AmpC phenotype. Resistance to β-lactam and non-β-lactam agents was significantly higher among MBL-PA isolates with the 82,5% of this multidrug-resistant. Only 18,8% (3/16) of MBLproducing strains were positive for the blaSPM-1 gene. To determine the genomic diversity of P.aeruginosa multidrug-resistant 20 isolates were analysed by macrorestriction profile analysis following PFGE. That showed of polyclonal Pseudomonas aeruginosa (16 genotypes). Altogether the detection of horizontal dissemination was observed in three patients (Clone A), two (Genotype C) and more two patients (Genotype E). The two epidemic MBL-PA isolates from the outbreak in 2003 presented macrorestriction profiles different from the endemic MBL-PA. The presence of MBL-PA in our unit indicates problems in nosocomial infection control practice, likely associated with low adherence to hand hygiene and especially in the abusive use of antibiotics.