Surgical site infection by carbapenemase-producing Enterobacteriaceae. A challenge for today's surgeons. / Infección de sitio quirúrgico asociada a enterobacterias productoras de carbapenemasas. Un desafío para el cirujano actual.
Cir Esp (Engl Ed)
; 98(6): 342-349, 2020.
Article
em En, Es
| MEDLINE
| ID: mdl-31980150
ABSTRACT
INTRODUCTION:
Infections caused by carbapenemase-producing Enterobacteriaceae (CPE) are dramatically increasing worldwide, with an important impact on surgical patients. Our aim was to assess the clinical profile, outcomes, treatment, mortality and costs of CPE-related surgical site infection (SSI) in patients with abdominal surgery.METHODS:
Review of CPE-related SSI in patients with abdominal surgery from January 2013 to December 2018. Patient factors and interventions present previously to the SSI identification were recorded, and a mortality analysis was also performed in patients with abdominal surgery and CPE-related organ/space SSI.RESULTS:
Fifty patients were included superficial incisional SSI 50%, deep incisional SSI 28%, organ/space SSI (or intra-abdominal infection) 70%. Klebsiella pneumoniae OXA-48 was present in 84%, and the most frequent were colorectal surgery (40%) and pancreatic surgery (20%). The antimicrobial susceptibility was ceftazidime-avibactam 100%, amikacin 91.7%, tigecycline 89.1%, colistin 70.8%, meropenem 62.8%, imipenem 52.1%. An appropriate definitive antimicrobial treatment was administered in 86%, using a combined scheme in 76%. Global 30-day mortality rate for intra-abdominal infection was 20%, and mortality-related factors were solid tumour (P=.009), solid metastasis (P=.009), septic shock (P=.02), blood transfusions (P=.03). Median global stay was 45 (IQR 26-67) days. Median global cost of hospitalization was 29,946 (IQR 15,405-47,749).CONCLUSIONS:
The clinical profile of patients with CPE-related SSI associates several comorbidities, interventions, prolonged stay and elevated costs. Mortality-related factors in intra-abdominal infection are solid tumour, metastasis, septic shock or blood transfusions.Palavras-chave
Antimicrobial stewardship; Carbapenem resistance; Carbapenemase-producing Enterobacteriaceae; Enterobacterias productoras de carbapenemasas; Infecciones quirúrgicas; Infección de sitio quirúrgico; Optimización de antibióticos; Pacientes quirúrgicos; Resistencia a carbapenémicos; Surgical infections; Surgical patients; Surgical site infection
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Base de dados:
MEDLINE
Assunto principal:
Infecção da Ferida Cirúrgica
/
Infecções por Enterobacteriaceae
/
Enterobacteriáceas Resistentes a Carbapenêmicos
Idioma:
En
/
Es
Ano de publicação:
2020
Tipo de documento:
Article