Avaliação da utilização de antimicrobianos para o tratamento de infecções relacionadas à assitência à saúde e resistência bacteriana em unidade de cuidados progressivos neonatal de referência

Abstract

Technologies and life support management have enhanced the survival of preterm infants. Neonates immune system is immature, which contribute to the occurrence of healthcare-associated infections (HAI). The overlap of several conditions with neonatal sepsis, the difficulty on diagnosis and laboratory confirmation in this period results in a tendency of over treat neonatal sepsis. This work aims to investigate the association of antimicrobial use and exposure time to the incidence of HAI by multi-resistant bacteria in a neonatal unit of references. In the period from 2008 to 2016, 2,751 newborns were hospitalized, corresponding to 60,656 patient-days. A total of 1398 HAI was diagnosed with cumulative incidence of 51% and density of 23 per 1000 patient-days. In the antimicrobial agents a total of 22,263 atm-day was observed, and for broad-spectrum antimicrobials 9,727 atm-day. When we compared the density of multi-resistant microorganisms by broad-spectrum atm-day, a significant increase was observed between the two periods when Gram-negative bacteria were observed for all broad-spectrum antimicrobials, carbapenems and 3rd and 4th generation cephalosporins. In our study, it was possible to find an association between the inappropriate use of broad spectrum antimicrobials and the increase of HAI by multi-resistant bacteria. Key-words: Sepsis; Drug Resistance, Microbial; Infant, Newborn; Anti-infective Agents