Microrganismos multidroga-resistentes na fronteira entre serviços de saúde e comunidade: uma abordagem espacial
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Data
2018-07-30
Autores
Del Masso-Pereira, Milena Aparecida
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Universidade Estadual Paulista (Unesp)
Resumo
Microrganismos multidroga-resistentes (MDR) tem se disseminado em hospitais, e apresentam potencial de transmissão em serviços não hospitares e saúde e mesmo na comunidade. Partindo deste princípio, desenvolvemos um estudo de metodologia mista de base individual e ecológica. O estudo foi conduzido no Hospital Estadual Bauru e distribuiu-se, resumidamente, em três etapas: (i) identificação de preditores para infecções por MDR com origem na comunidade (Community-onset [CO]-MDR); (ii) georreferenciamento e estudo da proximidade de domicílios de sujeitos com CO-MDR e outros que receberam alta hospitalar enquanto carreados de agente MDR (Retornando à Comunidade, RC) a serviços de saúde de complexidades diversas. No primeiro estudo, de delineamento caso-controle, identificamos internação prévia (com mais de seis meses de antecedência do diagnóstico) e doença pulmonar como fatores de risco para CO-MDR. Esses fatores apresentaram diferenças entre Gram-positivos e Gram-negativos. Já no segundo estudo, foi possível constatar a proximidade de domicílios de sujeitos dos grupos CO e RC com serviços de saúde, fossem eles Unidades Básicas (UBS), hospitais ou ambulatórios de especialidade. Em geral, quando comparados ao Methicillin-resistant Staphylococcus aureus (MRSA), outros agentes apresentavam maior dispersão em torno dos serviços de saúde. Os dados sugerem, ainda que indiretamente, a possibilidade de transmissão de microrganismos multidrogra-resistentes em espaços comunitários ou de assistência não hospitalar.
Multidrug-resistant microorganisms (MDR) have spread in hospitals, and have a potential for transmission in non-hospital healthcare settings and even in the community. This study was conducted in Bauru State Hospital and was distributed in three stages: (i) identification of predictors for community-onset MDR infections (CO-MDR); (ii) georeferencing and study of the proximity of CO-MDR and others who are discharged while harboring MDR (Returning to the Community, RC) to health services of diverse complexities.In the first case-control study, we identified previous hospitalization (with more than six months of the diagnosis) and pulmonary disease as risk factors for CO-MDR. These factors showed differences between Gram-positive and Gram-negative pathogens. In the second study, it was possible to verify the proximity of households of CO and RC subjects to health services, whether they were Basic Units (BHU), hospitals or specialty outpatient clinics. In general, when compared to Methicillin-resistant Staphylococcus aureus (MRSA), other agents were more dispersed around health services. The data suggest, albeit indirectly, the possibility of transmission of multidrug-resistant microorganisms in community or non-hospital care spaces.
Multidrug-resistant microorganisms (MDR) have spread in hospitals, and have a potential for transmission in non-hospital healthcare settings and even in the community. This study was conducted in Bauru State Hospital and was distributed in three stages: (i) identification of predictors for community-onset MDR infections (CO-MDR); (ii) georeferencing and study of the proximity of CO-MDR and others who are discharged while harboring MDR (Returning to the Community, RC) to health services of diverse complexities.In the first case-control study, we identified previous hospitalization (with more than six months of the diagnosis) and pulmonary disease as risk factors for CO-MDR. These factors showed differences between Gram-positive and Gram-negative pathogens. In the second study, it was possible to verify the proximity of households of CO and RC subjects to health services, whether they were Basic Units (BHU), hospitals or specialty outpatient clinics. In general, when compared to Methicillin-resistant Staphylococcus aureus (MRSA), other agents were more dispersed around health services. The data suggest, albeit indirectly, the possibility of transmission of multidrug-resistant microorganisms in community or non-hospital care spaces.
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Microrganismos multidroga-resistentes, fatores de risco, georreferenciamento, Multidrug-resistant organisms, risk fator, spatial epidemiology