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Master's Dissertation
DOI
https://doi.org/10.11606/D.9.2003.tde-09052022-125722
Document
Author
Full name
Emerson Danguy Cavassin
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2003
Supervisor
Committee
Mamizuka, Elsa Masae (President)
Costa, Silvia Figueiredo
Levy, Carlos Emilio
Title in Portuguese
Surto de infecção hospitalar causado por Klebsiella pneumoniae produtora de ESBL em uma UTI-neonatal: análise e impacto das medidas de controle
Keywords in Portuguese
ESBL
Infecção hospitalar
Resistência bacteriana
Surto
Abstract in Portuguese
Introdução: Microrganismos multirresistentes causadores de infecções hospitalares constituem um problema mundial e em ascensão, sendo os recém natos (RN) urna população especialmente exposta. Objetivo: Estudar a evolução de um surto causado por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em uma UTI-neonatal, bem como avaliar os fatores associados à ocorrência de infecção e o impacto das medidas de controle adotadas. Métodos: Foi estudada a população de RN (n=1.164) de uma UTI-Neo com taxa média de ocupação de 113% durante 36 meses (janeiro de 2000 a 2002). O surto, com duração de 7 meses, foi analisado através de ampla investigação microbiológica e epidemiológica tipo caso-controle. A relação genética entre as cepas foi estabelecida por eletroforese em campo variado em conjunto com a determinação do perfil plasmidial. As medidas de intervenção basearam-se nas precauções de contato, não sendo alterado o consumo de antimicrobianos. Resultados: Dos 218 pacientes expostos, 20 foram colonizados e 11 infectados por uma cepa geneticamente relacionada. A investigação microbiológica detectou a contaminação ambiental e das mãos da equipe. O grupo de pacientes infectados e/ou colonizados diferiu dos controles quanto ao uso de nutrição parenteral, transfusão e cateter venoso (p< 0,05), embora estes não pudessem ser definidos como fatores de risco. A intervenção resultou no controle do surto e erradicação da cepa epidêmica na unidade. Conclusão: A análise permitiu definir a natureza monoclonal do agente e sua disseminação, não sendo determinada a existência de um foco exógeno, a adoção de medidas de controle coincidiram com a erradicação da cepa epidêmica.
Title in English
Surto de infecção hospitalar causado por Klebsiella pneumoniae produtora de ESBL em uma UTI-neonatal: análise e impacto das medidas de controle
Keywords in English
Bacterial resistance
ESBL
Nosocomial infection
Outbreak
Abstract in English
Introduction: Multidrug-resistant microorganisms that cause nosocomial infections are a worldwide problem. The increasing incidence of neonatal infections caused by a new type of strain, the ESBL producing Klebsiella sp is becoming a major concern to the pediatrician. Aim: The aim of this study was to analyse an outbreak caused by Klebsiella sp in a neonatal intensive care unit (Neo ICU) in order to identify infection or colonisation associated factors of patients with the aid of the Hospital Infection Control Committee. Methods: A population of 1164 newborns of a Neo-ICU with a mean occupation rate of 113% during 36 months (Jan 2000 to Jan 2002) was studied. Toe seven-month outbreak was analysed by a microbiological and epidemiological investigation using a case-control design. The typing of Klebsiella sp strains was carried out by Pulsed Field Gel Electrophoresis (PFGE), and plasmidial profile, in order to establish clonal relationship between the samples. Intervention measures were solely based on contact precautions, the consumption of antimicrobial agents remaining unaltered. Results: Of the 218 patients exposed, 20 were colonised and 11 were infected by strains belonging to a single lineage. Contamination by Klebsiella sp was detected in the environment and in the hands of staff, through microbiological investigation. Patients who were colonised differed from those who showed infection through the use of parenteral nutrition, blood transfusions and central venous catheters (p<0.05), even though these parameters could not be considered as being risk factors. The intervention carried out was successful for the control and eradication of the epidemic strain from the ICU. Conclusion: Epidemiological analysis was able to identify the monoclonal outbreak of ESBL producing Klebsiella sp and characterise its spread pattern in the Neo ICU. An exogenous origin of the outbreak was not established, and the control measures adopted coincided with the eradication of the epidemic strain.
 
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Publishing Date
2022-05-09
 
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