Sazonalidade e determinantes meteorológicos da incidência de bacteremias nosocomiais por Acinetobacter baumannii em diversas regiões do Brasil
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Data
2021-02-24
Autores
Ferreira Filho, Sebastião Pires [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Infeções relacionadas à assistência à saúde (IRAS) são um importante problema de saúde pública em todo o mundo. Esse fenômeno é agravado pela resistência a antimicrobianos, que tem sido crescente em várias regiões, especialmente nos países em desenvolvimento (inclusive o Brasil). As IRAS são tradicionalmente associadas a processos de trabalho e gravidade dos pacientes. No entanto, nos últimos anos, tem surgido evidência de impacto de condições meteorológicas e sazonalidade da incidência de alguns patógenos associados à etiologia das IRAS. Entre esses patógenos tem destaque o Acinetobacter baumannii, que é hiperendêmico nos hospitais brasileiros. Realizamos um estudo para analisar a sazonalidade e o impacto de temperatura, umidade e pluviosidade sobre a incidência de infecções da corrente sanguínea por A. baumannii (ICSAB) em três hospitais de ensino localizados em diferentes Macrorregiões do Brasil: O Hospital das Clínicas da Faculdade de Medicina de Botucatu (Cidade de Botucatu, Estado de São Paulo, Região Sudeste); O Hospital da Universidade Federal de Goiás (Cidade de Goiânia, Estado de Goiás, Região Centro-Oeste) e o Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (Cidade de Fortaleza, Estado do Ceará, Região Nordeste). O período de coleta de dados foi de 2006 a 2015. Utilizamos análise de séries temporais (Box-Jenkins) ajustadas para sazonalidade e modelos de Regressão de Poisson para identificar os efeitos de interesse, com estratificação de resultados por região, por tipo de enfermaria e pelo perfil de resistência do A. baumannii aos carbapenêmicos. Nossos achados apontaram marcada sazonalidade e associação com temperatura no Hospital de Botucatu-SP, que também apresentou maior incidência de ICSAB. No Hospital de Goiânia, houve sazonalidade somente em isolados de Unidades de Terapia Intensiva, enquanto naquele de Fortaleza não foi detectada sazonalidade. Concluímos que a amplitude térmica e a incidência de ICSAB são determinantes do comportamento sazonal, e que o controle de temperatura pode ser uma estratégia adequada para sua prevenção.
Health care-associated infections (HCAIs) are a major public health problem worldwide. This phenomenon is aggravated by resistance to antimicrobials, which has been increasing in several regions, especially in developing countries (including Brazil). HCAIs are traditionally associated with work processes and patient severity. However, in recent years, there has been evidence of the impact of weather conditions and seasonality of the incidence of some pathogens associated with the etiology of HCAIs. Among these pathogens, Acinetobacter baumannii stands out, both for its seasonal behavior and for being hyperendemic in Brazilian hospitals. We conducted a study aimed at analyzing the seasonality and the impact of temperature, humidity and rainfall on the incidence of A. baumannii complex bloodstream infections (ABBSI) in three teaching hospitals located in different Macro-regions of Brazil: Clinics Hospital of Botucatu Mecial School (City of Botucatu, São Paulo State, Southeast Region); The teaching Hospital of the Federal University of Goiás (City of Goiânia, Goiás State, Midwest Region) and the University Hospital Walter Cantídio of the Federal University of Ceará (City of Fortaleza, Ceará State, Northeast Region). The data collection period was from 2006 to 2015. We used time series analysis (Box-Jenkins) adjusted for seasonality and Poisson Regression models to identify the effects of interest, with stratification of results by region, by type of ward and by the resistance profile of A. baumannii to carbapenems. Our findings pointed to marked seasonality and association with temperature at the Botucatu Hospital, which also presented higher incidence of ICSAB. In the Goiânia Hospital, there 19 was seasonality only for isolates from Intensive Care Units, while in the Fortaleza hospital no seasonality was detected. We conclude that the thermal amplitude and the incidence of ABBSI are determinants of seasonal behavior, and that temperature control can be an adequate strategy for its prevention.
Health care-associated infections (HCAIs) are a major public health problem worldwide. This phenomenon is aggravated by resistance to antimicrobials, which has been increasing in several regions, especially in developing countries (including Brazil). HCAIs are traditionally associated with work processes and patient severity. However, in recent years, there has been evidence of the impact of weather conditions and seasonality of the incidence of some pathogens associated with the etiology of HCAIs. Among these pathogens, Acinetobacter baumannii stands out, both for its seasonal behavior and for being hyperendemic in Brazilian hospitals. We conducted a study aimed at analyzing the seasonality and the impact of temperature, humidity and rainfall on the incidence of A. baumannii complex bloodstream infections (ABBSI) in three teaching hospitals located in different Macro-regions of Brazil: Clinics Hospital of Botucatu Mecial School (City of Botucatu, São Paulo State, Southeast Region); The teaching Hospital of the Federal University of Goiás (City of Goiânia, Goiás State, Midwest Region) and the University Hospital Walter Cantídio of the Federal University of Ceará (City of Fortaleza, Ceará State, Northeast Region). The data collection period was from 2006 to 2015. We used time series analysis (Box-Jenkins) adjusted for seasonality and Poisson Regression models to identify the effects of interest, with stratification of results by region, by type of ward and by the resistance profile of A. baumannii to carbapenems. Our findings pointed to marked seasonality and association with temperature at the Botucatu Hospital, which also presented higher incidence of ICSAB. In the Goiânia Hospital, there 19 was seasonality only for isolates from Intensive Care Units, while in the Fortaleza hospital no seasonality was detected. We conclude that the thermal amplitude and the incidence of ABBSI are determinants of seasonal behavior, and that temperature control can be an adequate strategy for its prevention.
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Palavras-chave
Acinetobacter baumannii, Sazonalidade, Estudo ecológico, Análise de séries temporais, Seasonality, Ecological study, Time series analysis