Epidemiología e impacto de las infecciones nosocomiales

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Abstract

Las infecciones nosocomiales (IN) son uno de los problemas más importantes que ocurren en las unidades de cuidados intensivos, por lo que es necesario conocer la epidemiología y el impacto que estas infecciones tienen en el paciente crítico. Se toman como base los datos del Estudio Nacional de Vigilancia de Infección Nosocomial en Unidades de Cuidados Intensivos y se hace una descripción de las tasas y de la etiología de las principales IN, como son la neumonía asociada a ventilación mecánica, la infección urinaria asociada a sondaje uretral y la bacteriemia primaria y secundaria. Se hace una revisión de la literatura médica con respecto a las consecuencias de las diferentes IN y se hace especial hincapié en las infecciones causadas por microorganismos multirresitentes.

Translated abstract

Nosocomial infections are one of the most important problems occurring in Intensive Care Units. For this reason, the epidemiology and impact of these infections on critical patients must be known. Based on the data from the ENVIN-UCI study, the rates and etiology of the main nosocomial infections, such as ventilator-associated pneumonia, urinary tract infection and primary and secondary bloodstream infection, have been described. A review of the literature regarding the impact of different nosocomial infections on critically ill patients, particularly those caused by multidrug-resistant bacteria, was also performed.

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Most cited references 177

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Invasive methicillin-resistant Staphylococcus aureus infections in the United States.

R. Monina Klevens, Melissa Morrison, Joelle Nadle … (2007)

As the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed. To describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005. Active, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA). Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains. There were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100,000; interval estimate, 92.6-156.9), blacks (66.5 per 100,000; interval estimate, 43.5-63.1), and males (37.5 per 100,000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100,000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care-associated infections in all surveillance areas. Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.

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Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.

Sara E Cosgrove, George Sakoulas, Eli Perencevich … (2003)

A meta-analysis was performed to summarize the impact of methicillin-resistance on mortality in Staphylococcus aureus bacteremia. A search of the MEDLINE database for studies published during the period of 1 January 1980 through 31 December 2000 and a bibliographic review identified English-language studies of S. aureus bacteremia. Studies were included if they contained the numbers of and mortality rates for patients with methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteremia. Data were extracted on demographic characteristics of the patients, adjustment for severity and comorbid illness, source of bacteremia, and crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for in-hospital mortality. When the results were pooled with a random-effects model, a significant increase in mortality associated with MRSA bacteremia was evident (OR, 1.93; 95% CI, 1.54-2.42; P<.001); significant heterogeneity was present. We explored the reasons for heterogeneity by means of subgroup analyses. MRSA bacteremia is associated with significantly higher mortality rate than is MSSA bacteremia.

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The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs.

Sara E Cosgrove (2006)

There is an association between the development of antimicrobial resistance in Staphylococcus aureus, enterococci, and gram-negative bacilli and increases in mortality, morbidity, length of hospitalization, and cost of health care. For many patients, inadequate or delayed therapy and severe underlying disease are primarily responsible for the adverse outcomes of infections caused by antimicrobial-resistant organisms. Patients with infections due to antimicrobial-resistant organisms have higher costs (approximately 6,000-30,000 dollars) than do patients with infections due to antimicrobial-susceptible organisms; the difference in cost is even greater when patients infected with antimicrobial-resistant organisms are compared with patients without infection. Strategies to prevent nosocomial emergence and spread of antimicrobial-resistant organisms are essential.

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Author and article information

Contributors

P.M. Olaechea: Role: ND

J. Insausti: Role: ND

A. Blanco: Role: ND

P. Luque: Role: ND

Journal

Journal ID (publisher-id): medinte

Title: Medicina Intensiva

Abbreviated Title: Med. Intensiva

Publisher: Elsevier España, S.L. (, , Spain )

ISSN (Print): 0210-5691

Publication date (Print and electronic): May 2010

Volume: 34

Issue: 4

Pages: 256-267

Affiliations

[03] Oviedo orgnameHospital Universitario Central de Asturias orgdiv1Servicio de Medicina Intensiva España

[01] orgnameHospital de Galdakao-Usansolo orgdiv1Servicio de Medicina Intensiva España

[02] Pamplona orgnameHospital de Navarra orgdiv1Servicio de Medicina Intensiva España

[04] Zaragoza orgnameHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Medicina Intensiva España

Article

Publisher ID: S0210-56912010000400006

DOI: 10.1016/j.medin.2009.11.013

SO-VID: 63ba2a20-f25a-4f87-9a33-c3f6f11e5430

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

History

Date received : 10 October 2009

Date accepted : 22 November 2009

Page count

Figures: 0, Tables: 0, Equations: 0, References: 101, Pages: 12

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SciELO Spain

Keywords: Infección nosocomial,Paciente crítico,Vigilancia epidemiológica,Impacto de la infección nosocomial,Nosocomial infection,Critical patient,Surveillance,Impact of nosocomial infection

Epidemiología e impacto de las infecciones nosocomiales Translated title: Epidemiology and impact of nosocomial infections

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Abstract

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SciELO Spain

Most cited references 177

Invasive methicillin-resistant Staphylococcus aureus infections in the United States.

Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.

The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs.

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