Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

Abstract

We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verifi ed through Chi-square test. The signifi cance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis. Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2%) and urinary (14%) sources and the ones related to central venous catheter (14%) were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05). Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%), Staphylococcus aureus (21%), and Klebsiella pneumoniae (14%) were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

Frequency of microorganisms isolated in patients with bacteremia in intensive care units in Colombia and their resistance profiles

“…Some authors have previously reported such change 8 and it has been proposed to be influenced by hospital clones being displaced by an increase in circulating community-derived clones having a multisensitivity pattern. 11 , 17 These clones’ participation has been identified in Colombia, North America and some Latin-American countries. A molecular study carried out in 2008 by Arias et al described similarities in the pattern of strains circulating in Colombia and the USA; this reinforced the need for establishing public health action in health care centres due to the risk of crossed dissemination in hospital services of such resistant strain coming from the community.…”

Epidemiología y pronóstico de pacientes con infección del torrente sanguíneo en 10 hospitales de Colombia

“…En Latinoamérica, aunque no existe el mismo volumen de información, se han realizado estudios epidemiológicos de bacteriemia en programas de vigilancia nacional en Brasil (SCOPE) 19 , o a partir del programa internacional de vigilancia de resistencia antimicrobiana SENTRY 20 . También se han realizado estudios retrospectivos 21,22 , prospectivos de un solo centro 23,24 o en poblaciones específicas de infecciones nosocomiales o pacientes hospitalizados en UCI 25,26 . La mortalidad cruda está entre 28,8 y 40% 19,22 y la mortalidad atribuible entre 17 y 37,8% 2,22,24 .…”

“…También se han realizado estudios retrospectivos 21,22 , prospectivos de un solo centro 23,24 o en poblaciones específicas de infecciones nosocomiales o pacientes hospitalizados en UCI 25,26 . La mortalidad cruda está entre 28,8 y 40% 19,22 y la mortalidad atribuible entre 17 y 37,8% 2,22,24 . En la mayoría de los estudios de Latinoamérica mencionados los microorganismos predominantes son bacilos gramnegativos, que representan entre 52 y 60% de los casos 19,27,28 ; pero en otros estudios, realizados en un solo centro en Argentina, predominaron las cocáceas grampositivas, entre 51,4 y 65,5% 22,29 .…”