Multicentre surveillance of epidemiologically important pathogens causing nosocomial bloodstream infections and pneumonia trials in Brazilian adult intensive care units

Abstract

Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem. Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil. Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections. Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case–control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed. Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3 %, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3 %), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs. Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.