Análise descritiva de casos de infecção primária de corrente sanguínea associada a cateter central em unidades de terapia intensiva

Abstract

Healthcare-associated infections (HAIs) are a global problem that increases morbidity and mortality, prolongs hospital stays, and raises healthcare costs. Among these infections, Central Line-Associated Bloodstream Infection (CLABSI) are among the most frequent and severe, particularly in Intensive Care Units (ICUs). The rise of antimicrobial resistance has complicated the treatment of these infections. The aim of this study was to identify the epidemiological profile of CLABSI in a tertiary hospital ICU in the Zona da Mata region of Minas Gerais. This retrospective, cross-sectional, and quantitative study analyzed medical records of patients admitted between 2018 and 2023 who were diagnosed with CLABSI. A total of 181 cases were identified, with a predominance of male patients (51.9%) and self-declared white patients (73.5%). The mean age was 65 years, ranging from 16 to 92 years. The mortality rate was high, reaching 79%, reflecting the severity of these infections. Most patients (90%) had comorbidities, with the most frequent being circulatory system diseases (59.6%) and metabolic conditions such as diabetes mellitus (42.5%). The central line was most commonly inserted in the right subclavian vein (33.7%), and the main indications for its use were the administration of vasopressors, positive inotropes, and vasodilators, as well as prolonged infusion therapy (89.5%). The average catheter duration was 18 days, and the average hospital stay was 75 days.The microbiological profile of the infections showed a predominance of Gram-negative bacteria (55.8%), particularly Klebsiella pneumoniae (37.6%) and Acinetobacter baumannii (23.7%). Among Gram-positive bacteria (38.7%), coagulase-negative Staphylococci (72.4%) and Staphylococcus aureus (20.3%) were the most prevalent. Antimicrobial resistance was notable, with Acinetobacter baumannii and Klebsiella pneumoniae showing resistance to aminoglycosides, beta-lactams, and carbapenems (over 90%). Among coagulase-negative Staphylococci, oxacillin resistance was 100%, and resistance to other antimicrobials was also high (95.7% to 94%). Catheter puncture was predominantly performed on the right side in subclavian veins (33.7%) and internal jugular veins (29.5%), strategies aimed at reducing complications such as pneumothorax.The study highlighted the severity of CLABSI, particularly due to the high rates of antimicrobial resistance, and the importance of the judicious use of central venous catheters. It also emphasized the need for preventive measures such as early catheter removal, the adoption of evidence-based practices, and the enhancement of microbiological surveillance strategies and rational use of antimicrobials.The study contributes to strengthening practices for the prevention and control of CLABSI, providing important data for the formulation of institutional protocols and the training of healthcare teams, especially in high-complexity settings. It also underscores the need for continued investigation and systematic interventions to reduce the incidence and adverse outcomes of these infections.