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Advisor(s)
Abstract(s)
As Enterobacterales são bactérias de Gram negativo comensais do intestino humano e são responsáveis por causar diversas infeções. Ao longo das últimas décadas estas bactérias desenvolveram resistência aos carbapenemos. As Enterobacterales Resistentes aos Carbapenemos (ERC) têm sido associadas a infeções em ambientes hospitalares e a uma elevada taxa de mortalidade, morbilidade e custos em saúde. Em resposta a esta ameaça tornou-se fundamental a implementação de medidas de prevenção e controlo de infeção e colonização e o desenvolvimento de estratégias terapêuticas para enfrentar a resistência aos carbapenemos nos bacilos de Gram negativo. Este estudo teve como objetivo principal avaliar a eficácia do protocolo de rastreio de colonização e o diagnóstico laboratorial de infeção por ERC num hospital da área de Lisboa e Vale do Tejo entre os anos de 2016 e 2021. Realizou-se a avaliação dos fatores de risco que levaram à ativação do protocolo de rastreio, sendo o internamento em hospital, unidade de cuidados continuados ou residenciais para pessoas idosas durante um período superior a 72 horas nos 12 meses anteriores à admissão, o principal fator. As principais ERC encontradas nos doentes colonizados e infetados foram a Klebsiella pneumoniae Carbapenemase (KPC) e Oxacilinase tipo 48 (OXA-48). Os resultados obtidos neste estudo demonstraram que apesar do aumento do número de doentes infetados por ERC, o impacto do protocolo de rastreio de colonização é positivo, visto que, foi possível detetar doentes colonizados previamente e ativar o seu isolamento, evitando a transmissão cruzada e consequentemente o aumento não só de doentes colonizados, mas também de doentes infetados em ambiente hospitalar.
ABSTRACT - Enterobacterales are Gram-negative bacteria that are commensal in the human intestine and are responsible for causing various infections. Over the last few decades, these bacteria have developed resistance to carbapenems. Carbapenem-resistant Enterobacterales (CRE) has been associated with infections in hospital settings and a high rate of mortality, morbidity, and healthcare costs. In response to this threat, it has become essential to implement measures to prevent and control infection and colonization and to develop therapeutic strategies to combat resistance to carbapenems in Gram-negative bacilli. This study's main goal was to evaluate the effectiveness of the colonization screening protocol and laboratory diagnosis of CRE infection in a Lisbon and Tagus Valley hospital between 2016 and 2021. An assessment of the risk factors that led to the activation of the screening protocol was carried out, with admission to a hospital, continued, or residential care unit for elderly people for more than 72 hours in the 12 months before admission, being the main factor. The main CREs found in colonized and infected patients were Klebsiella pneumoniae Carbapenemase (KPC) and Oxacillinase 48-type (OXA-48). The results obtained in this study demonstrated that despite the increase in the number of patients infected by CRE, the impact of the colonization screening protocol is positive, as it was possible to detect previously colonized patients and activate their isolation, avoiding cross-transmission and consequently the increase not only in colonized patients but also in infected patients in a hospital environment.
ABSTRACT - Enterobacterales are Gram-negative bacteria that are commensal in the human intestine and are responsible for causing various infections. Over the last few decades, these bacteria have developed resistance to carbapenems. Carbapenem-resistant Enterobacterales (CRE) has been associated with infections in hospital settings and a high rate of mortality, morbidity, and healthcare costs. In response to this threat, it has become essential to implement measures to prevent and control infection and colonization and to develop therapeutic strategies to combat resistance to carbapenems in Gram-negative bacilli. This study's main goal was to evaluate the effectiveness of the colonization screening protocol and laboratory diagnosis of CRE infection in a Lisbon and Tagus Valley hospital between 2016 and 2021. An assessment of the risk factors that led to the activation of the screening protocol was carried out, with admission to a hospital, continued, or residential care unit for elderly people for more than 72 hours in the 12 months before admission, being the main factor. The main CREs found in colonized and infected patients were Klebsiella pneumoniae Carbapenemase (KPC) and Oxacillinase 48-type (OXA-48). The results obtained in this study demonstrated that despite the increase in the number of patients infected by CRE, the impact of the colonization screening protocol is positive, as it was possible to detect previously colonized patients and activate their isolation, avoiding cross-transmission and consequently the increase not only in colonized patients but also in infected patients in a hospital environment.
Description
Mestrado em Tecnologias Clínico-Laboratoriais
Keywords
ERC Carbapenemos Rastreio Colonização Infeção CRE Carbapenems Screening Colonization Infection
Citation
Valério JP. Enterobacterales resistentes aos carbapenemos: controlo da infeção hospitalar [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2023.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa