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Advisor(s)
Abstract(s)
As bactérias multirresistentes são uma verdadeira ameaça à saúde pública à escala global e
a sua incidência tem vindo a aumentar nos últimos anos. São uma consequência da
prescrição e administração inapropriada de antibióticos que conduzem ao aumento da
resistência dos microrganismos.
As Enterobacteriáceas Resistentes a Carbapenemes (ERC) são um grupo de bactérias gramnegativas multirresistentes de crescente preocupação, uma vez que possuem rápida
capacidade de disseminação. Estas provocam frequentemente surtos de infeção, estando
associadas a condições com elevadas taxas de morbilidade e mortalidade e as suas opções
terapêuticas são bastante limitadas. Elas têm um elevado potencial de transmissão por
contacto direto, sobrevivendo e multiplicando-se perante concentrações relevantes de
carbapenemes. Os hospedeiros colonizados por estas Enterobacteriáceas podem
permanecer assintomáticos e, simultaneamente, servirem como reservatórios destas
bactérias. Elas causam também infeções associadas aos cuidados de saúde, como
bacteriemia, pneumonia e infeção do trato urinário. Estas bactérias têm não só um enorme
impacto clínico, como também graves consequências a nível socioeconómico.
Os fatores de risco para colonização ou infeção por ERC incluem exposição aos cuidados de
saúde, com internamentos prolongados ou frequentes em Unidades de Cuidados Intensivos
ou em Unidades de Cuidados de Longa Duração, utilização de antibioterapia de largo
espectro, presença de dispositivos invasivos, procedimentos cirúrgicos e invasivos,
comorbilidades do doente, imunossupressão, transplante, quimioterapia, diálise, contacto
próximo com um caso conhecido e viagens internacionais.
As medidas preventivas, se adotadas de forma correta e como parte de uma abordagem
multimodal, têm um enorme potencial. Essas medidas incluem isolamento de contacto,
coorte dos doentes e dos profissionais, formação e treino dos profissionais, diminuição do
uso de dispositivos invasivos, higiene das mãos e desinfeção do ambiente, prescrição
adequada de antibióticos e banho de clorohexidina. Há que identificar precocemente os
doentes infetados ou colonizados através de rastreios microbiológicos para que sejam
implementadas as medidas de prevenção e controlo de infeção e assim evitar a transmissão
cruzada. São impreteríveis o controlo de fatores de risco e o correto cumprimento das
medidas de prevenção.
Multidrug-resistant bacteria are a real threat to public health on a global scale with increasing incidence in the last years. They are a consequence of inappropriate prescription and administration of antibiotics which lead to increased resistance of microorganisms. Carbapenem-Resistant Enterobacteriaceae (CRE) are a group of multi-resistant gramnegative bacteria of increasing concern, since they have potential to spread widely. These bacteria often cause outbreaks and are associated with conditions with high mortality and morbidity rates and limited therapeutic options. They have a high potential for direct contact transmission, surviving and growing at relevant concentrations of carbapenems. Hosts colonized by these Enterobacteriaceae can remain asymptomatic and simultaneously serve as reservoirs for these bacteria. They can cause healthcare associated infections such as bacteraemia, pneumonia and urinary tract infection. These bacteria will not only have a huge clinical impact, but also serious socioeconomic consequences. Risk factors for colonization or infection by CRE include exposure to health care settings, with prolonged or frequent hospitalizations in intensive care units or long term care facilities, use of broad spectrum antibiotics, presence of invasive devices, invasive and surgical procedures, patient comorbidities, immunosuppression, transplantation, chemotherapy, dialysis, close contact with a known case and international travel. Adoption of infection control and prevention measures, as a part of a multimodal strategy, have an enormous potential. These measures include contact isolation, patient and staff cohorting, healthcare personnel training, decrease in the use of invasive devices, hand hygiene, environmental cleaning, antimicrobial stewardship and chlorhexidine bath. Early identification of infected or colonized patients through microbiological screening is crucial, so that infection control and prevention measures are implemented and thus prevent crosstransmission. Risk factors control and compliance with preventive measures are imperative.
Multidrug-resistant bacteria are a real threat to public health on a global scale with increasing incidence in the last years. They are a consequence of inappropriate prescription and administration of antibiotics which lead to increased resistance of microorganisms. Carbapenem-Resistant Enterobacteriaceae (CRE) are a group of multi-resistant gramnegative bacteria of increasing concern, since they have potential to spread widely. These bacteria often cause outbreaks and are associated with conditions with high mortality and morbidity rates and limited therapeutic options. They have a high potential for direct contact transmission, surviving and growing at relevant concentrations of carbapenems. Hosts colonized by these Enterobacteriaceae can remain asymptomatic and simultaneously serve as reservoirs for these bacteria. They can cause healthcare associated infections such as bacteraemia, pneumonia and urinary tract infection. These bacteria will not only have a huge clinical impact, but also serious socioeconomic consequences. Risk factors for colonization or infection by CRE include exposure to health care settings, with prolonged or frequent hospitalizations in intensive care units or long term care facilities, use of broad spectrum antibiotics, presence of invasive devices, invasive and surgical procedures, patient comorbidities, immunosuppression, transplantation, chemotherapy, dialysis, close contact with a known case and international travel. Adoption of infection control and prevention measures, as a part of a multimodal strategy, have an enormous potential. These measures include contact isolation, patient and staff cohorting, healthcare personnel training, decrease in the use of invasive devices, hand hygiene, environmental cleaning, antimicrobial stewardship and chlorhexidine bath. Early identification of infected or colonized patients through microbiological screening is crucial, so that infection control and prevention measures are implemented and thus prevent crosstransmission. Risk factors control and compliance with preventive measures are imperative.
Description
Keywords
Carbapenemes Enterobacteriáceas Fatores de Risco Multirresistência Prevenção