Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade
Ano de defesa: | 2014 |
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Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | , , |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Universidade Federal de Goiás
|
Programa de Pós-Graduação: |
Programa de Pós-graduação em Medicina Tropical e Saúde Publica (IPTSP)
|
Departamento: |
Instituto de Patologia Tropical e Saúde Pública - IPTSP (RG)
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | http://repositorio.bc.ufg.br/tede/handle/tede/11087 |
Resumo: | Stenotrophomonas maltophilia is a Gram-negative bacillus found in natural and in hospital environments. S maltophilia’s high level intrinsic resistence to antibiotics and heavy metals justifies the importance of this bacteria in the nosocomial environment. The aim of this study was to describe the clinical and epidemiological characteristics, and the outcome of infection due to S. maltophilia; describe the antibiotic sensitivity and the genetic relatedness from this bacteria from january 2010 to july 2013 in Hospital das Clínicas – UFG (HC/UFG). Clinical and epidemiological data were obtained from medical records of patients; antimicrobial sensitivity was determined by the methodology Vitek 2®; and the genetic similarity was determined by Pulsed-Field Gel Eletrophoresis (PFGE). Over the study period, 75 isolates of S. maltophilia were indentified in 56 patients, with mean of 1.34 isolates per patient (range 1-8). Among the total, 34.6% were in the clinical intensive care unit, and 17.3% in the clinical infirmary. The 3 intensive care unit accounted for 56% of all isolates. The mean age of patientes was 45.75 years (range 0-83 years), and 51.8% were male. All cases of infection were considered health care-associated. The most comom coexisting condition were haematological malignancy, in 18 (32.1%) patientes. The most frequent clinical manifestations was fever in 47 (83.9%) patients, and leukocytosis or leukopenia in 31 (55.4%). Invasive devices were frequently used, and central venous cateter, and mechanical ventilation were the most. Most patients (94.6%) used broad spectrum antibiotics before the acquisition of the bacteria. The most frequent type of infection was ventilator-associated pneumonia (42.9%) followed by cateter-associated bacteremia (16.1%). Trimethoprim-sulfamethoxazole was the treatment of choice in 32 (57.1%) patients. The outcome of infection due to S. maltophilia was infection-related death in 62.5%. The risk factors related to mortality in this study were shock, acute renal failure, use of mechanical ventilation, use of urinary device and feeding tube. Trimethoprim-sulfamethoxazole resistance, the treatment of choice for infection by S. maltophilia, and levofloxacin resistence were detected in HC / UFG. Twenty isolates were assessed for genetic variability by pulsed-field gel eletrophoresis (PFGE) with observation of high variability between strains. We conclude that S. maltophilia is a nosocomial bacteria of clinical importance mainly due to high associated mortality, and few therapeutic options. Resistance to trimethoprim/sulfamethoxazole was low, but must be monitored in HC / UFG. |
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Araújo Filho, João Alves dehttp://lattes.cnpq.br/3769452101687074Araújo Filho, João Alves deKipnis, AndréPereira, Milca Severinohttp://lattes.cnpq.br/3389688214551607Silva, Claudia Neto Gonçalves Neves da2021-02-08T13:57:07Z2021-02-08T13:57:07Z2014-07-08SILVA, C. N. G. N. Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade. 2014. 103 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2014.http://repositorio.bc.ufg.br/tede/handle/tede/11087Stenotrophomonas maltophilia is a Gram-negative bacillus found in natural and in hospital environments. S maltophilia’s high level intrinsic resistence to antibiotics and heavy metals justifies the importance of this bacteria in the nosocomial environment. The aim of this study was to describe the clinical and epidemiological characteristics, and the outcome of infection due to S. maltophilia; describe the antibiotic sensitivity and the genetic relatedness from this bacteria from january 2010 to july 2013 in Hospital das Clínicas – UFG (HC/UFG). Clinical and epidemiological data were obtained from medical records of patients; antimicrobial sensitivity was determined by the methodology Vitek 2®; and the genetic similarity was determined by Pulsed-Field Gel Eletrophoresis (PFGE). Over the study period, 75 isolates of S. maltophilia were indentified in 56 patients, with mean of 1.34 isolates per patient (range 1-8). Among the total, 34.6% were in the clinical intensive care unit, and 17.3% in the clinical infirmary. The 3 intensive care unit accounted for 56% of all isolates. The mean age of patientes was 45.75 years (range 0-83 years), and 51.8% were male. All cases of infection were considered health care-associated. The most comom coexisting condition were haematological malignancy, in 18 (32.1%) patientes. The most frequent clinical manifestations was fever in 47 (83.9%) patients, and leukocytosis or leukopenia in 31 (55.4%). Invasive devices were frequently used, and central venous cateter, and mechanical ventilation were the most. Most patients (94.6%) used broad spectrum antibiotics before the acquisition of the bacteria. The most frequent type of infection was ventilator-associated pneumonia (42.9%) followed by cateter-associated bacteremia (16.1%). Trimethoprim-sulfamethoxazole was the treatment of choice in 32 (57.1%) patients. The outcome of infection due to S. maltophilia was infection-related death in 62.5%. The risk factors related to mortality in this study were shock, acute renal failure, use of mechanical ventilation, use of urinary device and feeding tube. Trimethoprim-sulfamethoxazole resistance, the treatment of choice for infection by S. maltophilia, and levofloxacin resistence were detected in HC / UFG. Twenty isolates were assessed for genetic variability by pulsed-field gel eletrophoresis (PFGE) with observation of high variability between strains. We conclude that S. maltophilia is a nosocomial bacteria of clinical importance mainly due to high associated mortality, and few therapeutic options. Resistance to trimethoprim/sulfamethoxazole was low, but must be monitored in HC / UFG.Stenotrophomonas maltophilia é um bacilo Gram negativo encontrado tanto no ambiente hospitalar quanto na comunidade. A resistência intrínseca aos antimicrobianos (ATB) e aos metais é a característica principal desta bactéria. O objetivo deste trabalho foi estudar as características clínicas, epidemiológicas, e o desfecho da infecção por S. maltophilia; bem como estabelecer o perfil de sensibilidade antimicrobiana e a similaridade genética dos isolados desta bactéria no Hospital das Clínicas – UFG de Goiânia (HC/UFG) entre janeiro de 2010 a julho de 2013. Os dados clínicos e epidemiológicos foram obtidos de prontuários dos pacientes; a sensibilidade antimicrobiana foi determinada pela metodologia do aparelho Vitek 2®; e a similaridade genética foi determinada pela técnica de Pulsed-Field Gel Eletrophoresis (PFGE). No período estudado foram incluídas 75 cepas de S. maltophilia de 56 pacientes, com média de 1,34 isolados por paciente, variando de 1 a 8. Os setores de internação com maior positividade de isolados foram UTI Clínica, com 34,6% dos isolados; e Clínica Médica, com 17,3%. As 3 UTI foram responsáveis por 56% dos isolados. O sexo masculino foi o mais prevalente, com 51,8% dos casos, a média de idade foi 45,75 anos, e mediana 46 (variando de 0 a 83 anos de idade). Todos os casos foram classificados como infecção relacionada à assistência à saúde. A doença de base mais prevalente entre os pacientes foi neoplasia hematológica, com 18 (32,1%) pacientes. As manifestações clínicas mais encontradas foram febre em 47 (83,9%) pacientes, e leucocitose ou leucopenia em 31 (55,4%). O uso de dispositivos invasivos pelos pacientes foi frequente, sendo cateter venoso central (CVC) e ventilação mecânica (VM) os mais utilizados. O uso de antimicrobianos de amplo espectro antes do isolamento de S. maltophilia ocorreu em 53 (94,6%) pacientes. A infecção mais prevalente foi pneumonia associada à ventilação mecânica (PAVM) (42,9%) seguida por infecção de corrente sanguínea relacionada a cateter vascular e não relacionada a cateter vascular, com 16,1% cada. O tratamento da infecção mais realizado foi a associação sulfametoxazol/trimetoprim (SMX/TMP) em 32 (57,1%) pacientes. O desfecho final dos casos de infecção foi óbito relacionado à infecção em 62,5%. Os fatores associados à letalidade encontrados nesse estudo foram choque, insuficiência renal aguda, uso de VM, de SVD e de sonda nasoentérica (SNE) ou sonda nasogástrica (SNG). A resistência ao SMX/TMP, principal droga para tratamento de infecções por S. maltophilia, e a levofloxacina, foram detectadas no HC/UFG. Vinte isolados foram avaliados quanto à variabilidade genética por Pulsed-Field Gel Eletrophoresis, (PFGE) com observação de ampla variabilidade entre as cepas. Conclui-se que S. maltophilia é uma bactéria hospitalar de importância clínica principalmente devido a alta letalidade associada, e as escassas opções terapêuticas. A resistência encontrada ao sulfametoxazol/trimetoprim ainda foi baixa, porém deve-se continuar sendo monitorada no HC/UFG.Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2021-02-05T13:49:53Z No. of bitstreams: 2 license_rdf: 805 bytes, checksum: 4460e5956bc1d1639be9ae6146a50347 (MD5) Dissertação - Claudia Neto Gonçalves Neves da Silva - 2014.pdf: 2786674 bytes, checksum: ca5dc618d2a9d342a60fc814a2f4711f (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2021-02-08T13:57:07Z (GMT) No. of bitstreams: 2 license_rdf: 805 bytes, checksum: 4460e5956bc1d1639be9ae6146a50347 (MD5) Dissertação - Claudia Neto Gonçalves Neves da Silva - 2014.pdf: 2786674 bytes, checksum: ca5dc618d2a9d342a60fc814a2f4711f (MD5)Made available in DSpace on 2021-02-08T13:57:07Z (GMT). No. of bitstreams: 2 license_rdf: 805 bytes, checksum: 4460e5956bc1d1639be9ae6146a50347 (MD5) Dissertação - Claudia Neto Gonçalves Neves da Silva - 2014.pdf: 2786674 bytes, checksum: ca5dc618d2a9d342a60fc814a2f4711f (MD5) Previous issue date: 2014-07-08porUniversidade Federal de GoiásPrograma de Pós-graduação em Medicina Tropical e Saúde Publica (IPTSP)UFGBrasilInstituto de Patologia Tropical e Saúde Pública - IPTSP (RG)Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessStenotrophomonas maltophiliaLetalidadeInfecçãoStenotrophomonas maltophiliaLethalityInfectionCIENCIAS DA SAUDE::MEDICINAInfecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidadeStenotrophomonas maltophilia infection in a tertiary hospital in Goiânia: clinical, microbiological characteristics and lethality’s risk fatorinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis7050050050028178reponame:Repositório Institucional da UFGinstname:Universidade Federal de Goiás (UFG)instacron:UFGLICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repositorio.bc.ufg.br/tede/bitstreams/ff57c9b6-649f-4b82-ba58-b1a79610af7b/download8a4605be74aa9ea9d79846c1fba20a33MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805http://repositorio.bc.ufg.br/tede/bitstreams/32074cb6-517c-4d9b-b66b-1e17a2e53e95/download4460e5956bc1d1639be9ae6146a50347MD52ORIGINALDissertação - Claudia Neto Gonçalves Neves da Silva - 2014.pdfDissertação - Claudia Neto Gonçalves Neves da Silva - 2014.pdfapplication/pdf2786674http://repositorio.bc.ufg.br/tede/bitstreams/4b54c09b-5301-45b1-a6d5-9e718bd96e3a/downloadca5dc618d2a9d342a60fc814a2f4711fMD53tede/110872021-02-08 10:57:08.313http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internationalopen.accessoai:repositorio.bc.ufg.br:tede/11087http://repositorio.bc.ufg.br/tedeRepositório InstitucionalPUBhttp://repositorio.bc.ufg.br/oai/requesttasesdissertacoes.bc@ufg.bropendoar:2021-02-08T13:57:08Repositório Institucional da UFG - Universidade Federal de Goiás (UFG)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 |
dc.title.pt_BR.fl_str_mv |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
dc.title.alternative.eng.fl_str_mv |
Stenotrophomonas maltophilia infection in a tertiary hospital in Goiânia: clinical, microbiological characteristics and lethality’s risk fator |
title |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
spellingShingle |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade Silva, Claudia Neto Gonçalves Neves da Stenotrophomonas maltophilia Letalidade Infecção Stenotrophomonas maltophilia Lethality Infection CIENCIAS DA SAUDE::MEDICINA |
title_short |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
title_full |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
title_fullStr |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
title_full_unstemmed |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
title_sort |
Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade |
author |
Silva, Claudia Neto Gonçalves Neves da |
author_facet |
Silva, Claudia Neto Gonçalves Neves da |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Araújo Filho, João Alves de |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/3769452101687074 |
dc.contributor.referee1.fl_str_mv |
Araújo Filho, João Alves de |
dc.contributor.referee2.fl_str_mv |
Kipnis, André |
dc.contributor.referee3.fl_str_mv |
Pereira, Milca Severino |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/3389688214551607 |
dc.contributor.author.fl_str_mv |
Silva, Claudia Neto Gonçalves Neves da |
contributor_str_mv |
Araújo Filho, João Alves de Araújo Filho, João Alves de Kipnis, André Pereira, Milca Severino |
dc.subject.por.fl_str_mv |
Stenotrophomonas maltophilia Letalidade Infecção |
topic |
Stenotrophomonas maltophilia Letalidade Infecção Stenotrophomonas maltophilia Lethality Infection CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Stenotrophomonas maltophilia Lethality Infection |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
Stenotrophomonas maltophilia is a Gram-negative bacillus found in natural and in hospital environments. S maltophilia’s high level intrinsic resistence to antibiotics and heavy metals justifies the importance of this bacteria in the nosocomial environment. The aim of this study was to describe the clinical and epidemiological characteristics, and the outcome of infection due to S. maltophilia; describe the antibiotic sensitivity and the genetic relatedness from this bacteria from january 2010 to july 2013 in Hospital das Clínicas – UFG (HC/UFG). Clinical and epidemiological data were obtained from medical records of patients; antimicrobial sensitivity was determined by the methodology Vitek 2®; and the genetic similarity was determined by Pulsed-Field Gel Eletrophoresis (PFGE). Over the study period, 75 isolates of S. maltophilia were indentified in 56 patients, with mean of 1.34 isolates per patient (range 1-8). Among the total, 34.6% were in the clinical intensive care unit, and 17.3% in the clinical infirmary. The 3 intensive care unit accounted for 56% of all isolates. The mean age of patientes was 45.75 years (range 0-83 years), and 51.8% were male. All cases of infection were considered health care-associated. The most comom coexisting condition were haematological malignancy, in 18 (32.1%) patientes. The most frequent clinical manifestations was fever in 47 (83.9%) patients, and leukocytosis or leukopenia in 31 (55.4%). Invasive devices were frequently used, and central venous cateter, and mechanical ventilation were the most. Most patients (94.6%) used broad spectrum antibiotics before the acquisition of the bacteria. The most frequent type of infection was ventilator-associated pneumonia (42.9%) followed by cateter-associated bacteremia (16.1%). Trimethoprim-sulfamethoxazole was the treatment of choice in 32 (57.1%) patients. The outcome of infection due to S. maltophilia was infection-related death in 62.5%. The risk factors related to mortality in this study were shock, acute renal failure, use of mechanical ventilation, use of urinary device and feeding tube. Trimethoprim-sulfamethoxazole resistance, the treatment of choice for infection by S. maltophilia, and levofloxacin resistence were detected in HC / UFG. Twenty isolates were assessed for genetic variability by pulsed-field gel eletrophoresis (PFGE) with observation of high variability between strains. We conclude that S. maltophilia is a nosocomial bacteria of clinical importance mainly due to high associated mortality, and few therapeutic options. Resistance to trimethoprim/sulfamethoxazole was low, but must be monitored in HC / UFG. |
publishDate |
2014 |
dc.date.issued.fl_str_mv |
2014-07-08 |
dc.date.accessioned.fl_str_mv |
2021-02-08T13:57:07Z |
dc.date.available.fl_str_mv |
2021-02-08T13:57:07Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
SILVA, C. N. G. N. Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade. 2014. 103 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2014. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/11087 |
identifier_str_mv |
SILVA, C. N. G. N. Infecção por Stenotrophomonas maltophilia em hospital terciário em Goiânia: características clínicas e microbiológicas e fatores de risco para letalidade. 2014. 103 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2014. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/11087 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
70 |
dc.relation.confidence.fl_str_mv |
500 500 500 |
dc.relation.department.fl_str_mv |
28 |
dc.relation.cnpq.fl_str_mv |
178 |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Medicina Tropical e Saúde Publica (IPTSP) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Instituto de Patologia Tropical e Saúde Pública - IPTSP (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
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