RESUMO Objetivo: Determinar a prevalência, os desfechos e os preditores de infecções do trato respiratório inferior (ITRI) nosocomiais em pacientes em uma UTI. Métodos: Estudo observacional de coorte com pacientes com ITRI nosocomiais (pneumonia associada à assistência à saúde, pneumonia adquirida no hospital ou pneumonia associada à ventilação mecânica). Os dados foram coletados prospectivamente entre 2015 e 2019. Os patógenos multirresistentes (PMR) identificados nos isolados estudados incluíram Acinetobacter baumannii, Klebsiella pneumoniae e Pseudomonas aeruginosa resistentes a cefalosporinas de espectro estendido e carbapenêmicos, enterobactérias resistentes a carbapenêmicos e Staphylococcus aureus resistente à meticilina no diagnóstico microbiológico. Resultados: Durante o período do estudo, 267 pacientes internados na UTI foram diagnosticados com ITRI, 237 dos quais tiveram confirmação microbiológica de ITRI. Destes, 146 (62%) apresentaram pelo menos um isolado de PMR. Os pacientes infectados por PMR tiveram piores desfechos do que os infectados por cepas sensíveis, como ventilação mecânica prolongada (18,0 dias vs. 12,0 dias; p < 0,001), tempo prolongado de internação na UTI (23,0 dias vs. 16,0 dias; p < 0,001) e maior mortalidade (73% vs. 53%; p < 0,001). Tempo de internação hospitalar ≥ 5 dias (OR = 3,20; IC95%: 1,39-7,39; p = 0,005) e uso prolongado de drogas vasoativas (OR = 3,15; IC95%: 1,42-7,01; p = 0,004) foram preditores independentes de ITRI por PMR (ITRI-PMR). A presença de ITRI-PMR foi um preditor independente de óbito (OR = 2,311; IC95%: 1,091-4,894; p = 0,028). Conclusões: O uso prolongado de drogas vasoativas e o tempo prolongado de internação hospitalar foram preditores independentes de ITRI-PMR nesta população de pacientes críticos com desfechos muito ruins. Objetivo prevalência (ITRI Métodos saúde mecânica. . mecânica) 201 2019 (PMR baumannii microbiológico Resultados estudo 26 23 Destes 14 62% 62 (62% sensíveis 18,0 180 18 0 (18, vs 120 12 12, 0,001, 0001 0,001 , 001 23,0 230 (23, 160 16 16, 73% 73 (73 53% 53 0,001. OR 3,20 320 3 20 IC95% IC95 IC 1,397,39 139739 1,39 7,39 1 39 7 1,39-7,39 0,005 0005 005 3,15 315 15 1,427,01 142701 1,42 7,01 42 01 1,42-7,01 0,004 0004 004 ITRIPMR. ITRIPMR (ITRI-PMR) 2,311 2311 2 311 1,0914,894 10914894 1,091 4,894 091 4 894 1,091-4,894 0,028. 0028 0,028 028 0,028) Conclusões ruins 6 (62 18, (18 000 0,00 00 23, (23 (7 3,2 32 IC9 397 1,397,3 13973 139 1,3 739 7,3 1,39-7,3 3,1 31 427 1,427,0 14270 142 1,4 701 7,0 1,42-7,0 (ITRI-PMR 2,31 231 0914 1,0914,89 1091489 1091 1,09 4894 4,89 09 89 1,091-4,89 002 0,02 02 (6 (1 0,0 (2 ( 3, 1,397, 1397 13 1, 7, 1,39-7, 1,427, 1427 70 1,42-7, 2,3 1,0914,8 109148 109 1,0 489 4,8 8 1,091-4,8 0, 1,397 1,39-7 1,427 1,42-7 2, 1,0914, 10914 10 48 4, 1,091-4, 1,39- 1,42- 1,0914 1,091-4 1,091-
ABSTRACT Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrug-resistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay ≥ 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes. Objective prevalence multidrugresistant multidrug (LRTI Methods health careassociated care associated pneumonia hospitalacquired acquired ventilatorassociated ventilator pneumonia. . pneumonia) 201 2019 (MDRPs extendedspectrum extended spectrum cephalosporinresistant cephalosporin carbapenemresistant carbapenem baumannii pneumoniae aeruginosa Enterobacteriaceae methicillinresistant methicillin diagnosis Results period 26 237 these 14 62% 62 (62% isolate strains 18.0 180 18 0 (18. vs 120 12 12. 0.001, 0001 0.001 , 001 23.0 230 23 (23. vs160 16 vs.16. 73% 73 (73 53% 53 OR 3.20 320 3 20 95 CI 1.397.39 139739 1.39 7.39 1 39 7 1.39-7.39 0.005 0005 005 3.15 315 15 1.427.01 142701 1.42 7.01 42 01 1.42-7.01 0.004 0004 004 LRTIMDRP. LRTIMDRP (LRTI-MDRP) 2.311 2311 2 311 1.0914.894 10914894 1.091 4.894 091 4 894 1.091-4.894 0.028. 0028 0.028 028 0.028) Conclusions 6 (62 18. (18 000 0.00 00 23. (23 vs16 vs.16 (7 3.2 32 9 397 1.397.3 13973 139 1.3 739 7.3 1.39-7.3 3.1 31 427 1.427.0 14270 142 1.4 701 7.0 1.42-7.0 (LRTI-MDRP 2.31 231 0914 1.0914.89 1091489 1091 1.09 4894 4.89 09 89 1.091-4.89 002 0.02 02 (6 (1 0.0 (2 vs1 vs.1 ( 3. 1.397. 1397 13 1. 7. 1.39-7. 1.427. 1427 70 1.42-7. 2.3 1.0914.8 109148 109 1.0 489 4.8 8 1.091-4.8 0. 1.397 1.39-7 1.427 1.42-7 2. 1.0914. 10914 10 48 4. 1.091-4. 1.39- 1.42- 1.0914 1.091-4 1.091-