RESUMO
Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.
Assuntos
Infecções por Acinetobacter/economia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Carbapenêmicos/farmacologia , Custos de Cuidados de Saúde , Resistência beta-Lactâmica , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colômbia , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
El sujeto es una construcción que permite comprender una época y una sociedad. Su estudio es vital para esclarecer las formas en que los seres humanos se relacionan. Los autores construccionistas aquí estudiados convergen en sus ideas relacionales versus la identidad moderna de un sujeto racional y auténtico. A su vez, se exponen y debaten algunas críticas a esta mirada relacional del construccionismo social, que lo responsabilizan de ser una especie de disolvente del sujeto y no un visualizador de un sujeto cambiante, acogido a los tiempos.
The subject is a construction that allows us to understand a certain period and a society. Its study is key to clarify the ways in which human beings relate to each other. Constructionist authors studied here converge in their relational ideas versus the modern identity of a rational, authentic subject. At the same time, some criticisms of this relational look of Social Constructionism are presented and debated, looks that hold it responsible for being a kind of subject dissolvent, instead of viewing a changing, time-admitting subject.