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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.contributor.advisorNaranjo Junoy, Francisco Fernandospa
dc.contributor.authorGarcía Corzo, Carlos Miguelspa
dc.contributor.authorMozo Pérez, Fernandospa
dc.coverage.spatialFloridablanca (Santander, Colombia)spa
dc.date.accessioned2020-06-26T19:59:25Z
dc.date.available2020-06-26T19:59:25Z
dc.date.issued2013
dc.identifier.urihttp://hdl.handle.net/20.500.12749/1721
dc.description.abstractOBJETIVO: 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.spa
dc.description.tableofcontentsINTRODUCCION 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 61spa
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dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleFactores 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 - FOSCALspa
dc.title.translatedFactors 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 - FOSCALeng
dc.degree.nameEspecialista en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.coverageBucaramanga (Santander, Colombia)spa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsMedicineeng
dc.subject.keywordsCritical medicineeng
dc.subject.keywordsIntensive adult careeng
dc.subject.keywordsInvestigationseng
dc.subject.keywordsRelationship with patientseng
dc.subject.keywordsHealthcare-associated infectioneng
dc.subject.keywordsAntimicrobial resistanceeng
dc.subject.keywordsMultidrug resistant organismseng
dc.subject.keywordsRisk factorseng
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.contributor.cvlachttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095*
dc.subject.lembMedicinaspa
dc.subject.lembMedicina críticaspa
dc.subject.lembCuidado intensivo del adultospa
dc.subject.lembInvestigacionesspa
dc.subject.lembRelación con los pacientesspa
dc.description.abstractenglishOBJECTIVE: 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.eng
dc.subject.proposalInfección asociada al cuidado de la salud
dc.subject.proposalResistencia antimicrobiana
dc.subject.proposalMicroorganismo multirresistente
dc.subject.proposalFactores de riesgo
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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