Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL

OBJETIVO: Identificar factores asociados con aislamiento de microorganismos multirresistentes (MMR) en infecciones asociadas al cuidado de la salud (IACS), en las unidades de cuidados intensivos (UCI) de la clínica FOSCAL. PACIENTES Y METODOS: Se diseñó un estudio retrospectivo de casos y controles,...

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Autores:
García Corzo, Carlos Miguel
Mozo Pérez, Fernando
Tipo de recurso:
Fecha de publicación:
2013
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/1721
Acceso en línea:
http://hdl.handle.net/20.500.12749/1721
Palabra clave:
Medicine
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Healthcare-associated infection
Antimicrobial resistance
Multidrug resistant organisms
Risk factors
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Infección asociada al cuidado de la salud
Resistencia antimicrobiana
Microorganismo multirresistente
Factores de riesgo
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openAccess
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_ac3993ae8651613fa92b33eb3d47a358
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/1721
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
dc.title.translated.eng.fl_str_mv Factors associated with bacterial multidrug resistance in patients with healthcare-associated infection hospitalized in the adult intensive care unit of the Ophthalmological Foundation of Santander. Carlos Ardila Lulle Clinic - FOSCAL
title Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
spellingShingle Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
Medicine
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Healthcare-associated infection
Antimicrobial resistance
Multidrug resistant organisms
Risk factors
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Infección asociada al cuidado de la salud
Resistencia antimicrobiana
Microorganismo multirresistente
Factores de riesgo
title_short Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
title_full Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
title_fullStr Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
title_full_unstemmed Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
title_sort Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL
dc.creator.fl_str_mv García Corzo, Carlos Miguel
Mozo Pérez, Fernando
dc.contributor.advisor.spa.fl_str_mv Naranjo Junoy, Francisco Fernando
dc.contributor.author.spa.fl_str_mv García Corzo, Carlos Miguel
Mozo Pérez, Fernando
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095
dc.subject.keywords.eng.fl_str_mv Medicine
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Healthcare-associated infection
Antimicrobial resistance
Multidrug resistant organisms
Risk factors
topic Medicine
Critical medicine
Intensive adult care
Investigations
Relationship with patients
Healthcare-associated infection
Antimicrobial resistance
Multidrug resistant organisms
Risk factors
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Infección asociada al cuidado de la salud
Resistencia antimicrobiana
Microorganismo multirresistente
Factores de riesgo
dc.subject.lemb.spa.fl_str_mv Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
dc.subject.proposal.none.fl_str_mv Infección asociada al cuidado de la salud
Resistencia antimicrobiana
Microorganismo multirresistente
Factores de riesgo
description OBJETIVO: Identificar factores asociados con aislamiento de microorganismos multirresistentes (MMR) en infecciones asociadas al cuidado de la salud (IACS), en las unidades de cuidados intensivos (UCI) de la clínica FOSCAL. PACIENTES Y METODOS: Se diseñó un estudio retrospectivo de casos y controles, entre enero de 2010 y junio de 2011. Los datos se obtuvieron de la historia clínica electrónica, y se evaluaron los factores asociados con desarrollo de multirresistencia comparando dos grupos: 64 casos y 144 controles. RESULTADOS: Los factores asociados con multirresistencia fueron; exposición previa a antibióticos (OR = 3,47, IC 1.53 a 7.83, P = 0,003,) y uso de nutrición parenteral (OR = 4,07, IC 1.46 a 11.32, P = 0,007). El germen más frecuentemente aislado fue Klebsiella pneumoniae, pero aquel con mayor porcentaje de multirresistencia fue Acinetobacter baumannii. Hubo importante resistencia combinada a los principales grupos de antimicrobianos. Para enterobacterias fue alta la tasa de resistencia a ampicilina sulbactam, cefalosporinas de 3 y 4 generación, piperacilina tazobactam y quinolonas. En gram negativos no fermentadores lo fue para piperacilina tazobactam, carbapenémicos, monobactámicos y cefalosporinas antipseudomonas. Para gram positivos el número de aislamientos y la multirresistencia fueron bajos, (un solo caso de S aureus meticilino resistente, y un Streptococcus viridans vancorresistente). No hubo relación significativa entre el tipo de IACS y la aparición de multirresistencia. CONCLUSIONES: La infección por MMR se asoció significativamente al uso previo de antibióticos y de nutrición parenteral. Los perfiles de resistencia en MMR concuerdan con otros descritos a nivel nacional y mundial. Se requieren estudios prospectivos adicionales para validar estos hallazgos y vigilar los perfiles de susceptibilidad bacteriana.
publishDate 2013
dc.date.issued.none.fl_str_mv 2013
dc.date.accessioned.none.fl_str_mv 2020-06-26T19:59:25Z
dc.date.available.none.fl_str_mv 2020-06-26T19:59:25Z
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/1721
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
url http://hdl.handle.net/20.500.12749/1721
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv García Corzo, Carlos Miguel, Mozo Pérez, Fernando (2013). Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo adultos de la fundación oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL. Bucaramanga (Santander, Colombia) : Universidad Autónoma de Bucaramanga UNAB
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spelling Naranjo Junoy, Francisco FernandoGarcía Corzo, Carlos MiguelMozo Pérez, Fernandohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095Floridablanca (Santander, Colombia)Bucaramanga (Santander, Colombia)2020-06-26T19:59:25Z2020-06-26T19:59:25Z2013http://hdl.handle.net/20.500.12749/1721instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABOBJETIVO: Identificar factores asociados con aislamiento de microorganismos multirresistentes (MMR) en infecciones asociadas al cuidado de la salud (IACS), en las unidades de cuidados intensivos (UCI) de la clínica FOSCAL. PACIENTES Y METODOS: Se diseñó un estudio retrospectivo de casos y controles, entre enero de 2010 y junio de 2011. Los datos se obtuvieron de la historia clínica electrónica, y se evaluaron los factores asociados con desarrollo de multirresistencia comparando dos grupos: 64 casos y 144 controles. RESULTADOS: Los factores asociados con multirresistencia fueron; exposición previa a antibióticos (OR = 3,47, IC 1.53 a 7.83, P = 0,003,) y uso de nutrición parenteral (OR = 4,07, IC 1.46 a 11.32, P = 0,007). El germen más frecuentemente aislado fue Klebsiella pneumoniae, pero aquel con mayor porcentaje de multirresistencia fue Acinetobacter baumannii. Hubo importante resistencia combinada a los principales grupos de antimicrobianos. Para enterobacterias fue alta la tasa de resistencia a ampicilina sulbactam, cefalosporinas de 3 y 4 generación, piperacilina tazobactam y quinolonas. En gram negativos no fermentadores lo fue para piperacilina tazobactam, carbapenémicos, monobactámicos y cefalosporinas antipseudomonas. Para gram positivos el número de aislamientos y la multirresistencia fueron bajos, (un solo caso de S aureus meticilino resistente, y un Streptococcus viridans vancorresistente). No hubo relación significativa entre el tipo de IACS y la aparición de multirresistencia. CONCLUSIONES: La infección por MMR se asoció significativamente al uso previo de antibióticos y de nutrición parenteral. Los perfiles de resistencia en MMR concuerdan con otros descritos a nivel nacional y mundial. Se requieren estudios prospectivos adicionales para validar estos hallazgos y vigilar los perfiles de susceptibilidad bacteriana.INTRODUCCION 14 1 PREGUNTA DE INVESTIGACION 16 2 OBJETIVOS DEL PROYECTO 17 2.1 OBJETIVO GENERAL 17 2.2 OBJETIVOS ESPECIFICOS 17 3 MARCO TEORICO 18 3.1 DEFINICIONES 19 3.1.1 Infección 19 3.1.2 Infección asociada al cuidado de la salud (IACS) 19 3.1.3 Resistencia antimicrobiana 19 3.1.4 Microorganismo multirresistente (MMR) 20 3.2 FACTORES DE RIESGO ASOCIADOS A DESARROLLO DE MULTIRRESISTENCIA 21 3.2.1 Edad avanzada 21 3.2.2 Exposición previa a antibióticos 22 3.2.3 Género 22 3.2.4 Presencia de dispositivos invasivos 22 3.2.5 Inmunosupresión 22 3.2.6 Severidad de la enfermedad 23 3.2.7 Presencia de comorbilidad o enfermedad subyacente grave 23 3.2.8 Transfusiones 23 3.2.9 Tiempo de hospitalización en UCI y tiempo total de hospitalización 23 3.2.10 Carga de trabajo en UCI 23 3.2.11 Cirugía reciente 24 3.2.12 Hemodiállisis 24 4 METODOLOGIA PROPUESTA 25 4.1 TIPO DE ESTUDIO 25 4.2 UNIVERSO Y MUESTRA 25 4.2.1 Población de estudio 25 4.2.2 Criterios de inclusión 25 4.2.3 Criterios de exclusión 25 4.2.4 Muestra 25 4.2.4.1 Definición de caso 25 4.2.4.2 Definición de control 26 4.3 VARIABLES 26 4.4 RECOPILACION DE LA INFORMACION 28 4.5 PLAN DE ANALISIS 28 5 CONSIDERACIONES ETICAS 30 6 RESULTADOS 31 7 DISCUSION 47 8 CONCLUSIONES 50 BIBLIOGRAFIA 52 ANEXOS 61EspecializaciónOBJECTIVE: To identify factors associated with isolation of Multidrug-Resistant Organisms (MDRO) in patients with Healthcare-Associated Infection (HAI) in the intensive care units (ICU) at FOSCAL Hospital. PATIENTS & METHODS: A retrospective case-control study was performed between January 2010 and June 2011. Clinical data were obtained from electronic patient records, and the risk factors associated with isolation of MDRO were determined by comparison of case group (64 patients) with a control group (144 patients). RESULTS: Factors found to be associated with isolation of MDRO were prior antimicrobial therapy (OR = 3,47, IC 1.53 a 7.83, P = 0,003) and total parenteral nutrition (OR = 4,07, IC 1.46 a 11.32, P = 0,007). Klebsiella pneumoniae was the most frequently isolated bacteria, but Acinetobacter baumannii had the highest percentage of multidrug resistance. There was a significant combined resistance to major antimicrobials groups. Enterobacteriaceae had a high resistance rate to ampicillin / sulbactam, third and fourth-generation cephalosporins, piperacilline / tazobactam and quinolones. Non fermenter gram negative were resistant to piperacilline / tazobactam, carbapenems, monobactams and cephalosporins with specific antipseudomonal activity. Gram positive bacteria isolates were of low number and low resistance rate (a single case of Methicillin Resistant Staphylococcus aureus, and another case of Vancomycin resistant Streptococcus viridans). The type of HAI was not significantly associated with MDRO acquisition. CONCLUSIONS: Infection by MDRO was significantly associated to prior use of antibiotics and parenteral nutrition support. The bacterial resistance patterns were consistent with those reported nationally and globally. Additional prospective studies are needed to validate these findings, and for monitoring antimicrobial susceptibility patterns.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaFactores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo de adultos de la Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCALFactors associated with bacterial multidrug resistance in patients with healthcare-associated infection hospitalized in the adult intensive care unit of the Ophthalmological Foundation of Santander. Carlos Ardila Lulle Clinic - FOSCALEspecialista en Medicina Crítica y Cuidado Intensivo del AdultoUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Crítica y Cuidado Intensivo del Adultoinfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMMedicineCritical medicineIntensive adult careInvestigationsRelationship with patientsHealthcare-associated infectionAntimicrobial resistanceMultidrug resistant organismsRisk factorsMedicinaMedicina críticaCuidado intensivo del adultoInvestigacionesRelación con los pacientesInfección asociada al cuidado de la saludResistencia antimicrobianaMicroorganismo multirresistenteFactores de riesgoGarcía Corzo, Carlos Miguel, Mozo Pérez, Fernando (2013). Factores asociados con multirresistencia bacteriana en pacientes con infección asociada al cuidado de la salud hospitalizados en la unidad de cuidado intensivo adultos de la fundación oftalmológica de Santander Clínica Carlos Ardila Lulle - FOSCAL. Bucaramanga (Santander, Colombia) : Universidad Autónoma de Bucaramanga UNAB1. Safdar, N, Abad C. Educational interventions for prevention of healthcare-associated infection: A systematic review. Crit Care Med 2008; 36:933–9402. Organización Mundial de la Salud. Resolución WHA55.18. Ginebra: Organización Mundial de la Salud, 2002.3. Rosenthal VD, Maki DG, Salomao R, Álvarez-Moreno C, Mehta Y, Higuera F, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006; 145:582-91.4. Rosenthal VD, Maki DG, Mehta A, Álvarez-Moreno C, Leblebicioglu H, Higuera F, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2002-2007, issued January 2008. 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