Fatores associados às infecções multirresistentes em crianças hospitalizadas: estudo caso controle

Abstract

Those tolerated by multidrug-resistant microorganisms are a public health problem, considered a threat to global public health, and may have repercussions on morbidity, mortality, prolonged hospitalization and increased hospitalization costs. Among the affected individuals are hospitalized children, who are considered due to the developing development of the immune system in children, risk of cross-infection transmitted by a family member or companion, susceptibility to antimicrobials. In addition to the characteristics of children, there are factors associated with multidrug-resistant infections, which it is necessary to know for decision-making and planning of infection prevention and control actions. This work has the general objective of identifying the factors associated with multidrug-resistant infections in children hospitalized at a public pediatric hospital in Bahia. Case-control study carried out in a public pediatric hospital in Bahia between April 2021 and November 2022, using the Hospital Infection Control Commission database and electronic medical records of children hospitalized with the

community. Cases were defined as children who developed healthcare-related multidrug- resistant infections, and controls were children who developed healthcare-associated

complications caused by a non-multidrug-resistant microorganism. Data analysis was performed using descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 24.0. This research is made up of 395 treated patients, with 114 cases (28.9%) and 281 controls (71.1%), with a ratio of 1:2.5 between cases and controls. Of the cases of multidrug-resistant vomiting, females predominated (n=60; 52.6%), the age group of infants (n=58; 50.9%), heart diseases (n=22; 19.3%) and respiratory diseases (n=19; 16.7%). In the case group, there was a greater number of children using more than 1 antibiotic (n=60; 52.6%), predominant use of the antimicrobial classes of Penicillin (n=42; 36.8%) and Glycopeptides ( n=39; 34.2%) and the classes of antimicrobials with greater resistance were Penicillin (n=25; 21.9%) and B-lactams (n=31; 27.2%). Among those that survived, IPCS (n=61; 53.5%) and VAP (n=15; 13.2%) prevailed in the case group. Regarding the number of HAIs, the occurrence of 1 HAI prevailed in both groups of children (n=80; 70.2%) and the most predominant microorganisms were Klebsiella (n=37; 32.5%), followed by Staphylococcus (n=25; 21.9%). Factors associated with the risk of multidrug-resistant toxicity were the use of NGT [OR 1.8 (1.01-3.56), p=0.043] and length of stay. The protective factors for multidrug resistant patients were gender [OR 0.5 (0.37-0.91), p=0.017] and gastrointestinal diseases [OR 0.3 (0.18-0.76), p = 0.006]. In risk factors, recent surgery and chronic disease prevailed both in the case and control groups. Our results demonstrated the importance of knowing the factors associated with infections for the prevention and control of multidrug-resistant infections.