Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia
Ano de defesa: | 2012 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Universidade Federal de Goiás
|
Programa de Pós-Graduação: |
Doutorado em Ciencias da Saude
|
Departamento: |
Ciencias da Saude
|
País: |
BR
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | http://repositorio.bc.ufg.br/tede/handle/tde/1543 |
Resumo: | This cross-sectional study was performed in the dressing rooms of the primary healthcare network of Goiânia, Goiás, Brasil, with the following objectives: to identify the prevalence of Gram-negative bacteria (GNB) in venous ulcers (VU) with clinical signs of infection; analyze the susceptibility profile of the isolates; detect the production of AmpC β-lactamases and metallo-beta-lactamases, and extended spectrum beta-lactamase (ESBL); describe the clinical signs and symptoms of infection in VU; evaluate the wounds clinical stage of infection and its relationship with the presence of GNB. The data were analyzed by means of descriptive statistics procedures, proportion and Chi-square tests (p<0.05). All ethical aspects were followed. The participants were 69 patients with venous ulcers, with or without arterial complication, totaling 98 wounds. It was verified that 74.5% of the wounds showed GNB growth, particularly enterobacteria (53.8%) and non-fermenting gram-negative bacteria (46.2%). The prevalent species among the enterobacteria was Escherichia coli (24.5%), followed by Enterobacter aerogenes, Pantoea agglomerans and Proteus mirabilis (12.2% each). Regarding the non-fermenting gram-negative bacteria, the prevalent genre was Pseudomonas (66.6%), particularly the species P. aeruginosa (59.5%), present in 25.5% of the analyzed wounds. Regarding the susceptibility profile of the enterobacteria, the highest resistance rates were to tetracycline (38.8%) and amoxicillin-clavulanic acid (26.5%). Among P. aeruginosa, the highest resistance was observed for cefoxitin (100%). Regarding the production of the AmpC enzyme, 30% of the microorganisms in the CESP (Citrobacter spp., Enterobacter spp., Serratia spp. and Providencia spp.) group, and 100% of the P. aeruginosa were resistant to cefoxitin. The remaining microorganisms of the CESP group (70%) that were sensitive to cefoxitin were subjected to a confirmatory test, and 37.5% were found to be positive for the production of the AmpC enzyme. Regarding metallo-beta-lactamase, 23.8% of the non-fermenting gram-negative bacteria showed reduced sensitivity to imipenem, meropenem or ceftazidime. When subjected to the confirmatory test, 8% of the P. aeruginosa were positive for the MBL enzyme. Regarding the clinical signs and symptoms of infection, the highlighted results with >70% frequency are: opaque and/or reddish brown discoloration; increase in exudate volume and pain. Stage-three infection was the most prevalent (71.4%). An association was found between cellulitis and friable granulation tissue that bleeds easily and the culture for GNB. In conclusion, the presence of gram-negative pathogens with resistance profiles in primary healthcare patients suggests the need to implement microbiological surveillance for patients with VU experiencing a prolonged or difficult healing process, and that the identification VU infection should be guided by knowledge regarding the etiology, classic characteristic and clinical stages of infection. |
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BACHION, Maria Marciahttp://lattes.cnpq.br/8503907944360635http://lattes.cnpq.br/2461784381351166SANTOS, Silvana de Lima Vieira dos2014-07-29T15:25:21Z2012-10-022012-03-30SANTOS, Silvana de Lima Vieira dos. Clinical and microbiological analysis of the venous ulcers of patients treated at Basic Health Centers of Goiânia. 2012. 193 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2012.http://repositorio.bc.ufg.br/tede/handle/tde/1543This cross-sectional study was performed in the dressing rooms of the primary healthcare network of Goiânia, Goiás, Brasil, with the following objectives: to identify the prevalence of Gram-negative bacteria (GNB) in venous ulcers (VU) with clinical signs of infection; analyze the susceptibility profile of the isolates; detect the production of AmpC β-lactamases and metallo-beta-lactamases, and extended spectrum beta-lactamase (ESBL); describe the clinical signs and symptoms of infection in VU; evaluate the wounds clinical stage of infection and its relationship with the presence of GNB. The data were analyzed by means of descriptive statistics procedures, proportion and Chi-square tests (p<0.05). All ethical aspects were followed. The participants were 69 patients with venous ulcers, with or without arterial complication, totaling 98 wounds. It was verified that 74.5% of the wounds showed GNB growth, particularly enterobacteria (53.8%) and non-fermenting gram-negative bacteria (46.2%). The prevalent species among the enterobacteria was Escherichia coli (24.5%), followed by Enterobacter aerogenes, Pantoea agglomerans and Proteus mirabilis (12.2% each). Regarding the non-fermenting gram-negative bacteria, the prevalent genre was Pseudomonas (66.6%), particularly the species P. aeruginosa (59.5%), present in 25.5% of the analyzed wounds. Regarding the susceptibility profile of the enterobacteria, the highest resistance rates were to tetracycline (38.8%) and amoxicillin-clavulanic acid (26.5%). Among P. aeruginosa, the highest resistance was observed for cefoxitin (100%). Regarding the production of the AmpC enzyme, 30% of the microorganisms in the CESP (Citrobacter spp., Enterobacter spp., Serratia spp. and Providencia spp.) group, and 100% of the P. aeruginosa were resistant to cefoxitin. The remaining microorganisms of the CESP group (70%) that were sensitive to cefoxitin were subjected to a confirmatory test, and 37.5% were found to be positive for the production of the AmpC enzyme. Regarding metallo-beta-lactamase, 23.8% of the non-fermenting gram-negative bacteria showed reduced sensitivity to imipenem, meropenem or ceftazidime. When subjected to the confirmatory test, 8% of the P. aeruginosa were positive for the MBL enzyme. Regarding the clinical signs and symptoms of infection, the highlighted results with >70% frequency are: opaque and/or reddish brown discoloration; increase in exudate volume and pain. Stage-three infection was the most prevalent (71.4%). An association was found between cellulitis and friable granulation tissue that bleeds easily and the culture for GNB. In conclusion, the presence of gram-negative pathogens with resistance profiles in primary healthcare patients suggests the need to implement microbiological surveillance for patients with VU experiencing a prolonged or difficult healing process, and that the identification VU infection should be guided by knowledge regarding the etiology, classic characteristic and clinical stages of infection.Estudo transversal realizado nas salas de curativos da atenção primária a saúde em Goiânia, Goiás, Brasil, cujos objetivos foram identificar a prevalência de bastonetes Gram-negativos (BGN) em úlceras venosas (UV) com sinais clínicos de infecção; analisar o perfil de suscetibilidade dos isolados; detectar a produção de β-lactamases tipo AmpC, metalo-beta-lactamase e ESBL; descrever os sinais e sintomas clínicos de infecção em UV; avaliar o estágio clínico de infecção das lesões e a relação destes com a presença de BGN. Utilizou-se de análise descritiva, teste de proporções e Qui-quadrado (p<0,05). Os aspectos éticos foram observados. Participaram 69 pacientes com úlceras venosas com ou sem complicações arteriais, totalizando 98 lesões. Verificou-se que em 74,5% das lesões houve crescimento de BGN. Foram identificadas Enterobactérias (53,8%) e bastonetes Gram-negativos não fermentadores (46,2%). Dentre as enterobactérias prevaleceu a espécie Escherichia coli (24,5%), seguida de Enterobacter aerogenes, Pantoea aglomerans e Proteus mirabillis com 12,2% cada um. Em relação aos bastonetes Gram-negativos não fermentadores, destacou-se a prevalência do gênero Pseudomonas com 66,6% e em especial a espécie P. aeruginosa com 59,5%, presente em 25,5% das feridas analisadas. Quanto ao perfil de suscetibilidade das enterobactérias, destacaram-se a resistência à tetraciclina (38,8%), à amoxacilina-ácido clavulânico (26,5%). Entre as P. aeruginosa, a maior resistência foi observada para cefoxitina (100%). Quanto à produção de enzima AmpC, 30% dos micro-organismos do grupo CESP e 100% das P. aeruginosa foram resistentes a cefoxitina. Os demais micro-organismos do grupo CESP (70%) sensíveis à cefoxitina foram submetidos ao teste confirmatório e 37,5% apresentaram-se positivos a produção de enzima AmpC. Em relação a metalo-beta-lactamase, 23,8% dos bastonetes Gram-negativos não fermentadores apresentaram sensibilidade reduzida ao imipenem, meropenem ou ceftazidima. Ao serem submetidos ao teste confirmatório, observou-se que 8% das P. aeruginosa foram positivas para a enzima MBL. Não foi identificada ESBL. Quanto aos sinais e sintomas clínicos de infecção na lesão, destacaram-se, com freqüência >70%: descoloração do tipo opaca e/ou tijolo vermelho escuro; aumento do volume do exsudato e dor. O estágio três de infecção foi o mais prevalente (71,4%). Houve relação entre celulite e tecido de granulação friável que sangra facilmente e o resultado de cultura para BGN. Conclui-se que a presença de patógenos Gram-negativos resistentes em pacientes na atenção primária a saúde sugere a necessidade de instituir-se vigilância microbiológica para os pacientes com UV com processo cicatricial de difícil evolução e que a identificação de infecção nas UV deve ser norteada pelo conhecimento acerca da etiologia, características clássicas e estágios clínicos de infecção.Made available in DSpace on 2014-07-29T15:25:21Z (GMT). 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dc.title.por.fl_str_mv |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
dc.title.alternative.eng.fl_str_mv |
Clinical and microbiological analysis of the venous ulcers of patients treated at Basic Health Centers of Goiânia |
title |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
spellingShingle |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia SANTOS, Silvana de Lima Vieira dos Úlcera venosa infecção bactéria Gram-negativa enfermagem venous ulcer infection gram-negative bacteria nursing CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
title_short |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
title_full |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
title_fullStr |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
title_full_unstemmed |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
title_sort |
Análise clínica e microbiológica de úlceras venosas de pacientes atendidos em Unidades Básicas de Saúde de Goiânia |
author |
SANTOS, Silvana de Lima Vieira dos |
author_facet |
SANTOS, Silvana de Lima Vieira dos |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
BACHION, Maria Marcia |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8503907944360635 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/2461784381351166 |
dc.contributor.author.fl_str_mv |
SANTOS, Silvana de Lima Vieira dos |
contributor_str_mv |
BACHION, Maria Marcia |
dc.subject.por.fl_str_mv |
Úlcera venosa infecção bactéria Gram-negativa enfermagem |
topic |
Úlcera venosa infecção bactéria Gram-negativa enfermagem venous ulcer infection gram-negative bacteria nursing CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
dc.subject.eng.fl_str_mv |
venous ulcer infection gram-negative bacteria nursing |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
description |
This cross-sectional study was performed in the dressing rooms of the primary healthcare network of Goiânia, Goiás, Brasil, with the following objectives: to identify the prevalence of Gram-negative bacteria (GNB) in venous ulcers (VU) with clinical signs of infection; analyze the susceptibility profile of the isolates; detect the production of AmpC β-lactamases and metallo-beta-lactamases, and extended spectrum beta-lactamase (ESBL); describe the clinical signs and symptoms of infection in VU; evaluate the wounds clinical stage of infection and its relationship with the presence of GNB. The data were analyzed by means of descriptive statistics procedures, proportion and Chi-square tests (p<0.05). All ethical aspects were followed. The participants were 69 patients with venous ulcers, with or without arterial complication, totaling 98 wounds. It was verified that 74.5% of the wounds showed GNB growth, particularly enterobacteria (53.8%) and non-fermenting gram-negative bacteria (46.2%). The prevalent species among the enterobacteria was Escherichia coli (24.5%), followed by Enterobacter aerogenes, Pantoea agglomerans and Proteus mirabilis (12.2% each). Regarding the non-fermenting gram-negative bacteria, the prevalent genre was Pseudomonas (66.6%), particularly the species P. aeruginosa (59.5%), present in 25.5% of the analyzed wounds. Regarding the susceptibility profile of the enterobacteria, the highest resistance rates were to tetracycline (38.8%) and amoxicillin-clavulanic acid (26.5%). Among P. aeruginosa, the highest resistance was observed for cefoxitin (100%). Regarding the production of the AmpC enzyme, 30% of the microorganisms in the CESP (Citrobacter spp., Enterobacter spp., Serratia spp. and Providencia spp.) group, and 100% of the P. aeruginosa were resistant to cefoxitin. The remaining microorganisms of the CESP group (70%) that were sensitive to cefoxitin were subjected to a confirmatory test, and 37.5% were found to be positive for the production of the AmpC enzyme. Regarding metallo-beta-lactamase, 23.8% of the non-fermenting gram-negative bacteria showed reduced sensitivity to imipenem, meropenem or ceftazidime. When subjected to the confirmatory test, 8% of the P. aeruginosa were positive for the MBL enzyme. Regarding the clinical signs and symptoms of infection, the highlighted results with >70% frequency are: opaque and/or reddish brown discoloration; increase in exudate volume and pain. Stage-three infection was the most prevalent (71.4%). An association was found between cellulitis and friable granulation tissue that bleeds easily and the culture for GNB. In conclusion, the presence of gram-negative pathogens with resistance profiles in primary healthcare patients suggests the need to implement microbiological surveillance for patients with VU experiencing a prolonged or difficult healing process, and that the identification VU infection should be guided by knowledge regarding the etiology, classic characteristic and clinical stages of infection. |
publishDate |
2012 |
dc.date.available.fl_str_mv |
2012-10-02 |
dc.date.issued.fl_str_mv |
2012-03-30 |
dc.date.accessioned.fl_str_mv |
2014-07-29T15:25:21Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
SANTOS, Silvana de Lima Vieira dos. Clinical and microbiological analysis of the venous ulcers of patients treated at Basic Health Centers of Goiânia. 2012. 193 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2012. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tde/1543 |
identifier_str_mv |
SANTOS, Silvana de Lima Vieira dos. Clinical and microbiological analysis of the venous ulcers of patients treated at Basic Health Centers of Goiânia. 2012. 193 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2012. |
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http://repositorio.bc.ufg.br/tede/handle/tde/1543 |
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Universidade Federal de Goiás |
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Doutorado em Ciencias da Saude |
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UFG |
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BR |
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Ciencias da Saude |
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Universidade Federal de Goiás |
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