Infecções associadas a cuidados de saúde em pacientes cirróticos hospitalizados
Palavras-chave:
cirrose hepática, infecções, infecções associadas à saúdeResumo
Introdução: a cirrose hepática é uma das doenças mais frequentes em nosso país, e a presença de infecções e sua descompensação constituem motivos de internação nesses pacientes.
Objetivo: identificar as doenças associadas aos cuidados de saúde mais frequentes em pacientes cirróticos hospitalizados.
Método: foi realizado um estudo de coorte em 90 pacientes com diagnóstico de cirrose hepática, internados no Hospital Geral Provincial "Carlos Manuel de Céspedes" da província de Granma, no período de janeiro de 2017 a setembro de 2020. A população foi constituída por para todos os pacientes com mais de 18 anos de idade e de ambos os sexos. Os dados foram coletados em prontuários hospitalares. Na análise estatística, foi utilizada a estatística Qui-quadrado obtida em tabelas de contingência e, para medir a força dos riscos relativos (RR), foi utilizado um nível de significância (p-valor) menor que 0,05.
Resultados: a maioria dos pacientes era do sexo masculino, descompensados com Child-Pugh (B), sendo o álcool a etiologia mais frequente da cirrose, que realizaram cuidados de saúde como colocação de cateter vesical, abordagem venosa central e periférica, além de intubação endotraqueal. As principais infecções associadas aos cuidados de saúde observadas nestes pacientes foram flebite, bacteremia, infecção do trato urinário e pneumonia.
Conclusões: as infecções associadas aos cuidados de saúde em ordem de frequência foram flebite, bacteremia, pielonefrite, pneumonia e cistite.
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Referências
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14. Marciano S, Díaz JM, Gadano A. Spontaneus bacterial peritonitis in patients with cirrhosis, incidence Outcomes and treatment strategies. Hepat Med: Evidence and Res [Internet]. 2019 Jan [citado 20 Sep 2019]; (11):13-22. DOI: https://doi.org/10.2147/HMER.S164250
15. Wong J, Zhang Z, Yan X, Li M, Xia J, Liu Y, et al. Albumin-Bilirrubin (ALBI) an accurate an simple prognostic score for chronic hepatitis B-related liver cirrhosis. Dig Liver Dis [Internet]. 2019 [citado 20 Sep 2019]; 51(8):1172-78. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30765220/
16. Pen Y, Qi X, Who X. Child-Pugh versus MELD score for the Assesment of prognosis in liver cirrhosis. Medicine (Baltimore) [Internet]. 2016 Feb [Citado 20 Sep 2019]; 95(8):2877. DOI: https://dx.doi.org/10.1097%2FMD.0000000000002877
17. Majead A, Sagar F, Latif A, Hassan H, Iffikar A, Darnuchi RO, et al. Does antimicrobial coating and impregnation of urinary catheters prevent catthter-associated urinary tract Infection. A review of Clinical and preclinical studies. Exp Rev Med Dev [Internet]. 2019 Sep [citado 20 Sep 2019]; 16(9):809-20. DOI: https://doi.org/10.1080/17434440.2019.1661774
18. Yu S, Marshal AP, Li J, Ling F. Interventions and strategies to prevent catheter-associated urinary tract infections with short-term including urinary catheters in hospitalized patients: An integrative review. Int J Ners Pract [Internet]. 2020 [citado 20 Sep 2019]; 26(3):e12834. DOI: https://doi.org/10.1111/ijn.12834
19. Sato A, Nakamura I, Fujita H, Sukimari A, Kobayashi T, Fukushima S, et al. Peripheral venous catheter-related Bloodstream Infection is associated with severe complications and potential deth: a respective observational study. BMC Infec Des [Internet]. 2017 [citado 20 Sep 2019]; 17:434. Disponible en: https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/s12879-017-2536-0.pdf
20. Elzauki AN, Neffati N, Rosaul FA, Abdallah H, Othnem M, Waness A, et al. Increased risk of Spontaneus bacterial peritonitis in cirrhotic patients using proton pump inhibitors. GE Port J Gastroenterol [Internet]. 2019 Mar [citado 20 Sep 2019]; 26(2):83-89. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454390/
21. Xie Y, Tu B, Xu Z, Zhang X, Bi J, Zhao M, et al. Bacterial distributions and prognosis of Bloodstream infections in patients with liver cirrhosis. Sci Rep [Internet]. 2017 Sep [citado 20 Sep 2019]; 7(1):11482. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28904387/
22. Wu S, Ren S, Zhao H, Jin H, Xu L, Qia S, et al. Risk factos for central venous catheter-related Bloodstream infections in liver after Gastroenterol surgery. Am J Infec [Internet]. 2017 May [citado 20 Sep 2019]; 45(5):549-50. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28233571/
23. Sentarpia L, Bornamo A, Pagano MC, Alfuci L, Foggia M, Mattale M, et al. Central venous catheter related Bloodstream infections in adult patients in home parenteral nutrition: Prevalence, predictive, factors, therapeutic outcome. Clin Nutr [Internet]. 2016 Dec [citado 20 Sep 2019]; 35(6):1394-98. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27068496/
24. Méndez Guerrero IO, Álvarez Navarro N, Torre Delgadillo A. Impacto del estado nutricional en el pronóstico de pacientes con cirrosis hepática. REDCieN [Internet]. 2020 Ene-Jun [citado 20 Sep 2019]; 3(5):31-40. Disponible en: https://www.researchgate.net/publication/344158830_IMPACTO_DEL_ESTADO_NUTRICIONAL_EN_EL_PRONOSTICO_DE_PACIENTES_CON_CIRROSIS_HEPATICA
/VOLUMEN-COMPLETO-ENERO-JUNIO1-2019.pdf.pdf
2. Sotos Solano FJ. Análisis de los Pacientes Cirróticos Ingresados en las Unidades de Cuidados Intensivos. [Tesis Doctoral]. España: Universidad De Murcia; 2019. [citado 20 Sep 2020]. Disponible: http://hdl.handle.net/10201/67982.
3. Carrillo Esper R, Díaz Carrillo MA, Arch Tirado E, Zepeda Mendoza DZ, Meza Márquez JM, Pérez Calatayud AA. Correlación entre la clasificación Child-Pugh lactato y la mortalidad en pacientes cirróticos internados en la unidad de terapia intensiva. Med Crit [Internet]. 2016 [citado 20 Sep 2020]; 30(5):310-31.http://www.medigraphic.com/medicinacritica
4. Klímová K, Padilla C, Ávila JC, Clemente G, Ochoa A. Epidemiología de las infecciones bacterianas en pacientes con cirrosis hepática, experiencia de un centro español de atención terciaria. Biomédica [Internet]. 2016 [citado 20 Sep 2020]; 36(1):121-32. DOI: https://doi.org/10.7705/biomedica.v36i1.2600
5. Castillo Luna A, Cristina Longo C, Landeira G, et al. Las infecciones por bacterias multirresistentes en la cirrosis modifican el pronóstico de los pacientes. Acta Gastroenterol Latinoam [Internet]. 2017 [citado 20 Sep 2020]; 47(4):243-251. Disponible en: http://www.actagastro.org/numeros-anteriores/2017/Vol-47-N4/Vol47N4-PDF04.pdf
6. Sargenti K, Pritz H, Nilsson E, Kalaitzakis E.Predictors of mortality among patients with compensated and decompensated liver cirrhosis: the role of bacterial infections and infection-related acute-on-chronic liver failure. Scan J Gastroenterol [Internet]. 2015 Jul [citado 20 Sep 2020]; 50(7):875-83. DOI: https://doi.org/10.3109/00365521.2015.1017834
7. Biblioteca Médica Nacional. Cirrosis Hepática. Tratamiento. Bibliomed [Internet]. 2018 Nov [citado 20 Sep 2020]; 25(12):14. Disponible en: http://files.sld.cu/bmn/files/2018/11/bibliomed-noviembre-2018.pdf
8. Nodarse Hernández R. Visión actualizada de las infecciones Intrahospitalarias. Rev Cubana Med Mil [Internet]. 2002 [citado 20 Sep 2019]; 31(3):201-8. Disponible en: http://scielo.sld.cu/pdf/mil/v31n3/mil08302.pdf
9. Fortea JI, Crespo J. Cirrosis hepática. Medicine [Internet]. 2020 [citado 20 Sep 2019]; 13(6):297-307. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7352104
10. Horan TC, MPH, Andrus M, Dudeck MA. CDC/NHSN Surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control [Internet]. 2008 [citado 20 Sep 2019]; 36(5):309-32. DOI: https://doi.org/10.1016/j.ajic.2008.03.002
11. Powell E, Skoien R, Rahman T, Clark PJ, O'Beirne J, Hartel G. Increasing Hospitalization Rates for Cirrhosis: overrepresentation of disadvantaged australians. EClinical Med [Internet]. 2019 Jun [Citado 20 Sep 2019]; 11:44-53. DOI: https://doi.org/10.1016/j.eclinm.2019.05.007
12. Piano S, Singh V, Caraceni P, Maiwall R, Alessandria C, Fernández J, et al. Epidemiology and effects of bacterial infections in patients with cirrhosis worldwide. Gastroenterol [Internet]. 2019 Apr [citado 20 Sep 2019]; 156(5):1-13. DOI: https://doi.org/10.1053/j.gastro.2018.12.005
13. Di Pascoli M, Ceranto E, De Nardi P, Donato D, Gatta A, Angeli P, et al. Hospitalizations Due to Cirrhosis: clinical aspects in a large cohort of italian patients and cost analysis report. Dig Dis [Internet]. 2017 [citado 20 Sep 2019]; 35(5):433-38. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28245467/
14. Marciano S, Díaz JM, Gadano A. Spontaneus bacterial peritonitis in patients with cirrhosis, incidence Outcomes and treatment strategies. Hepat Med: Evidence and Res [Internet]. 2019 Jan [citado 20 Sep 2019]; (11):13-22. DOI: https://doi.org/10.2147/HMER.S164250
15. Wong J, Zhang Z, Yan X, Li M, Xia J, Liu Y, et al. Albumin-Bilirrubin (ALBI) an accurate an simple prognostic score for chronic hepatitis B-related liver cirrhosis. Dig Liver Dis [Internet]. 2019 [citado 20 Sep 2019]; 51(8):1172-78. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30765220/
16. Pen Y, Qi X, Who X. Child-Pugh versus MELD score for the Assesment of prognosis in liver cirrhosis. Medicine (Baltimore) [Internet]. 2016 Feb [Citado 20 Sep 2019]; 95(8):2877. DOI: https://dx.doi.org/10.1097%2FMD.0000000000002877
17. Majead A, Sagar F, Latif A, Hassan H, Iffikar A, Darnuchi RO, et al. Does antimicrobial coating and impregnation of urinary catheters prevent catthter-associated urinary tract Infection. A review of Clinical and preclinical studies. Exp Rev Med Dev [Internet]. 2019 Sep [citado 20 Sep 2019]; 16(9):809-20. DOI: https://doi.org/10.1080/17434440.2019.1661774
18. Yu S, Marshal AP, Li J, Ling F. Interventions and strategies to prevent catheter-associated urinary tract infections with short-term including urinary catheters in hospitalized patients: An integrative review. Int J Ners Pract [Internet]. 2020 [citado 20 Sep 2019]; 26(3):e12834. DOI: https://doi.org/10.1111/ijn.12834
19. Sato A, Nakamura I, Fujita H, Sukimari A, Kobayashi T, Fukushima S, et al. Peripheral venous catheter-related Bloodstream Infection is associated with severe complications and potential deth: a respective observational study. BMC Infec Des [Internet]. 2017 [citado 20 Sep 2019]; 17:434. Disponible en: https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/s12879-017-2536-0.pdf
20. Elzauki AN, Neffati N, Rosaul FA, Abdallah H, Othnem M, Waness A, et al. Increased risk of Spontaneus bacterial peritonitis in cirrhotic patients using proton pump inhibitors. GE Port J Gastroenterol [Internet]. 2019 Mar [citado 20 Sep 2019]; 26(2):83-89. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454390/
21. Xie Y, Tu B, Xu Z, Zhang X, Bi J, Zhao M, et al. Bacterial distributions and prognosis of Bloodstream infections in patients with liver cirrhosis. Sci Rep [Internet]. 2017 Sep [citado 20 Sep 2019]; 7(1):11482. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28904387/
22. Wu S, Ren S, Zhao H, Jin H, Xu L, Qia S, et al. Risk factos for central venous catheter-related Bloodstream infections in liver after Gastroenterol surgery. Am J Infec [Internet]. 2017 May [citado 20 Sep 2019]; 45(5):549-50. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28233571/
23. Sentarpia L, Bornamo A, Pagano MC, Alfuci L, Foggia M, Mattale M, et al. Central venous catheter related Bloodstream infections in adult patients in home parenteral nutrition: Prevalence, predictive, factors, therapeutic outcome. Clin Nutr [Internet]. 2016 Dec [citado 20 Sep 2019]; 35(6):1394-98. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27068496/
24. Méndez Guerrero IO, Álvarez Navarro N, Torre Delgadillo A. Impacto del estado nutricional en el pronóstico de pacientes con cirrosis hepática. REDCieN [Internet]. 2020 Ene-Jun [citado 20 Sep 2019]; 3(5):31-40. Disponible en: https://www.researchgate.net/publication/344158830_IMPACTO_DEL_ESTADO_NUTRICIONAL_EN_EL_PRONOSTICO_DE_PACIENTES_CON_CIRROSIS_HEPATICA
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2021-05-30
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Ricardo-Serrano YM, Rodríguez-Pereira A, Cabrera-Lavernia JO, Martí-Garcés GM, Pelaez-Llorente M. Infecções associadas a cuidados de saúde em pacientes cirróticos hospitalizados. Rev Inf Cient [Internet]. 30º de maio de 2021 [citado 2º de abril de 2025];100(3):e3455. Disponível em: https://revinfcientifica.sld.cu/index.php/ric/article/view/3455
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