Perfil microbiológico das pneumonias associadas com o ventilador (NAV) na Unidade de Tratamento intensivo (UTI) da Clínica Universitária Bolivariana (CUB), anos 2009-2011
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Objetivo: Descrever o perfil microbiológico das pneumonias associadas com o ventilador (NAV) na Unidade de Tratamento intensivo (UTI) da Clínica Universitária Bolivariana, 2009-2011.
Metodologia: Estudo descritivo, retrospectivo de único centro. Diagnóstico microbiológico por aspirado endotraqueal. As variáveis quantitativas se analisaram com medidas de agrupação, média e mediana e de dispersão como a desvio padrão, mínimos e máximos. As variáveis categóricas se analisaram como proporções.
Resultados: Ingressaram 34 pacientes, 19 homens (56%); idade média de 60 anos (DE 17.75) e uma média na pontuação Apache II de 17 (8-36). Os diagnósticos mais frequentes de ingresso foram: patologia pulmonar (24%), sepse (18%) e trauma (18%). A Klebsiella pneumoniae (23%) e a Pseudomonas aeruginosa (21%) foram os gérmenes mais frequentes. Se encontrou uma correlação de 59% entre os gérmenes isolados e os gérmenes implicados com a NAV tardia. Nos cultivos de faringe o Estreptococo viridans foi o principal germe (20%), seguido pela K. pneumoniae (16%) e a Escherichia Coli (16%). Somente houve uma correlação de 38% entre o cultivo de faringe e o aspirado endotraqueal.
Conclusões: A K. pneumoniae e a P. aeruginosa foram os gérmenes mais frequentes, com uma má correlação entre o cultivo de faringe e o aspirado endotraqueal.
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Referências
Bercault N, Boulain T. Mortality rate attributable to ventilator associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med. 2001;29(12):2303-9.
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867-903.
Ortiz G, Fonseca N, Molina F, Garay M, Lara A, Dueñas C. Epidemiología de la neumonía asociada a ventilador en 39 unidades de cuidados intensivos de Colombia (2007-2009). Informe año 2010. Acta Colom Cuid Intensiv. 2011;11(1):12-19.
Klompas M. Does this patient have ventilator-associated pneumonia? JAMA. 2007;297:1583-93.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med. 2008;36:1394-6.
Rello J, Vidaur L, Sandiumenge A, Rodríguez A, Gualis B, Boque C, et al. De-escalation therapy in ventilator-associated pneumonia. Crit Care Med. 2004;32:2183-90.
Yepes D, Molina F, Ortiz G, Aguirre R. Risk factors associated with the presence of pneumonia in patients with brain injury. Biomédica. 2009;29(2):253-9.
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867-903.
Kollef MH, Ward S. The influence of mini-BAL cultures on patients outcomes: Implications for the antibiotic management of ventilator associated pneumonia. Chest. 1998;113:412-20.
Luna CM, Vujacich P, Neiderman MS, Vay C, Gherardi C, Matera J, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676-85.
Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit: ICU-Acquired Pneumonia Study Group. Intensive Care Med. 1996;22:387-94.
American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
The Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619-30.
Sociedad Venezolana de Infectología. Consenso Venezolano de Neumonía Nosocomial. En: VII Congreso Venezolano de Infectología. Puerto Ordaz, Venezuela: Sociedad Venezolana de Infectología; 2006.
Diaz E, Planas K, Rello J. Infection associated with the use of assisted-ventilation devices. Enferm Infecc Microbiol Clin. 2008;26(7):465-70.
Olaechea PM, Insausti J, Blanco A, Luque P. Epidemiology and impact of nosocomial infections. Med Intensiva 2010;34(4):256-67.
Amaral SM, Cortês Ade Q, Pires FR. Nosocomial pneumonia: importance of the oral environment. J Bras Pneumol. 2009;35(11):1116-24.
Torres A, Ewig S. Diagnosing ventilator-associated pneumonia. N Engl J Med. 2004;350(5):433-5.
Langer M, Haeusler EA. Ventilator associated pneumonia (VAP): an impossible diagnosis? Call for a pragmatic approach. Minerva Anestesiol. 2009;75(10):584-90.
The Canadian Critical Care Trials Group. A Randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006;355:2619-30.
Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia: problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol. 2008;22(3):437-49.
Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004;350(5):451-8.
Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008;19(1):19-53.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilatorassociated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143(5 Pt 1):1121-9.
Balthazar AB, Von Nowakonski A, De Capitani EM, Bottini PV, Terzi RG, Araujo S. Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy. Braz J Med Biol Res. 2001;34(8):993-1001.
American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008;19(1):19-53.