Luna Carlos M, Rodriguez-Noriega Eduardo, Bavestrello Luis, Guzmán-Blanco Manuel
Pulmonary Division, Department of Medicine, José de San Martin Hospital, University of Buenos Aires, Arenales 2557, Piso 1, Dep. A, 1425 Buenos Aires, Argentina.
Hospital Civil de Guadalajara "Fray Antonio Alcalde" and Institute of Infectious and Experimental Pathology, University Center of Health Sciences, University of Guadalajara, Guadalajara, JAL, Mexico.
Crit Care Res Pract. 2014;2014:480463. doi: 10.1155/2014/480463. Epub 2014 Nov 27.
This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.
本综述总结了拉丁美洲和加勒比地区成人重症监护病房（ICU）中部分国家革兰氏阴性菌感染的近期流行病学情况。我们对生物医学文献（PubMed）进行了系统检索，以识别过去十年发表的文章。在适当情况下，还从已发表文章的参考文献列表、特定国家的卫生部门和登记处收集了数据。来自所有国家（阿根廷、巴西、智利、哥伦比亚、古巴、墨西哥、特立尼达和多巴哥以及委内瑞拉）的独立队列数据显示ICU感染率很高（患病率：阿根廷为24%；巴西为57%）。革兰氏阴性病原体，主要是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠杆菌，占ICU感染的50%以上，这些感染常因多重耐药菌株的存在和克隆性暴发而复杂化。抗菌药物的经验性使用被确定为耐药性发展和过高死亡率的一个重要危险因素。利用卫生措施和抗菌药物管理计划的感染控制策略降低了器械相关感染的发生率。为了减轻与多重耐药革兰氏阴性菌感染相关的不良健康后果，必须紧急关注感染控制策略和当地监测计划。
