Vigilancia activa de infecciones asociadas a la atención en salud en unidades de cuidado intensivo: perfil de resistencia y molecular en un pais en desarrollo
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Objetivo: Caracterizar el perfil epidemiologico molecular de infecciones asociadas al cuidado de la salud (IACS) en 21 unidades de cuidado intensivo (UCI) en una ciudad en Colombia. Metodos: Estudio descriptivo de prevalencia. Pacientes adultos fueron tamizados en 21 UCI para IACS: VAP, CLABSI; CAUTI y/o SSI. Se hizo identificación microbiológica y de genotipos. Resultados: La prevalencia of IACS fue de 41,4% (IC 36,9-45,9). VAP 15,8% (IC 12,7-19,4); CLABSI, 13,5% (IC 10,6-16,9); CAUTI, 7,7% (IC 5,5-10,5); y SSI, 4,4% (IC2,7-6,6). Predominaron bacterias Gram-negativas con 71,7%: P. aeruginosa (19,1%), K. pneumoniae (13,4%) y E. coli (13%). Pseudomonas spp. en 20-30% fueron resistentes al carbapenem y mayor que 10% al aztreonam, cefalosporinas de 3ra- y 4a-generacióne inhibidores de Beta-lactamasa. En VAP y CLABSI, el 30% de Staphylococcus aureus fueron resistentes a oxacilina. En CAUTI, Staphylococcus epidermidis mostró 100% de resistencia. Los genes de resistencia en P. aeruginosa fueron blaTEM, blaSHV, y blaCTX-M (15-32%), KPC (5.7%), y oxacillinasas blaOXA-48 (1,8%) y blaOXA-1-40-30 (20-50%). In E. coli, los genes qnrB, qnrS y qnrD fueron identificados. En CLABSI, ermC-type (16,7%), aph[2’]’If (7,7%) y ant[4’]-Ia (7.7%) se identificaron en Staphylococcus aureus. Conclusiones: VAP y CLABSI predominaron en la UCI en Colombia principlamente por presencia de bacterias gram-negativa con plasmidos tipo ESBL de bombas de flujo, dificultando el tratamiento de estos casos.
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