Bacteriemia nosocomial en servicios de Cuidados Críticos y en Sala General

Introduccion: las bacteriemias nosocomiales (BN) estan ampliamente estudiadas en servicios de cuidados criticos, principalmente la relacionada a cateteres venosos centrales (CVC). La importancia de las BN y su impacto clinico no ha sido estudiada en salas generales de internacion, en donde es cada vez mayor el uso de CVC y existe un uso extendido de cateteres venosos perifericos (CVP). Objetivo: nos propusimos comparar la BN ocurridas en salas de cuidados generales y en ereas de cuidados criticos. Metodos: estudio prospectivo descriptivo de BN desde 01/12/2008 hasta 30/06/2012, en un hospital de adultos de tercer nivel con 400 camas. Resultados: se registraron 361 bacteriemias: 50,9% nosocomiales, 16,1% relacionadas al sistema de salud y 32,9% comunitarias. De 184 BN se presentaron 52 episodios (28,3%) en servicios de cuidados criticos y 132 (71,3% en Sala General, principalmente en Clinica Medica (82,5%). El foco mas frecuente de las BN fue asociado a cateteres venosos (60%) y foco desconocido (28%). Los porcentajes de multirresistencia fueron similares en ambos ambitos. No hubo diferencias estadisticamente significativas en los Servicios de Cuidados Criticos comparado con la mortalidad por BN en Sala General (46,1% vs 46,9%; p=0,99). Conclusiones: el mayor porcentaje de BN se presento en servicios de cuidados no criticos, su impacto es relevante si consideramos que la mortalidad intrahospitalaria resulto similar a la de servicios de cuidados criticos. Siendo la principal causa de BN en sala general, la relacionada al uso de cateter venoso central y periferico, urge la necesidad de disenar protocolos para su colocacion y manejo. (AU) Introduction: Nosocomial Bloodstream Infections (NBI) are completely studied in critical care units, mainly those associated with central venous catheter (CVC). The significance and impact of NBI has not been analyzed in general wards, where there is an incresing use of CVC as well asan extended use of peripheral lines. Objective: we compared NBI in general wards with those occurred in critical care units. Methods: prospective, descriptive study performed from 01/12/2008 since 30/06/2012, in an adult third level 400-bed hospital. Results: we obtained 361 bloodstream infections: 50.9% nosocomial, 16.1% healthcare related and 32.9% community acquired. Out of 184 NBI episodes 52 (28.3%) were from critical care units and 132 (71,3%) from general wards, mainly internal medicine service (82.5%). The most frequent source of NBI was related to venous catheters (60%) and unknown focus (28%). Frequency of multirresistant microorganisms was similar in both areas. No statistically significant differences were found in the in-hospital mortality of NBI in critical care units and general wards (46.1% vs 46.9%; p=0.99). Conclusion: General wards presented the highest percentage of NBI. Its impact is relevant considering that the in-hospital mortality was similar tothat in critical care units. The main cause of NBI in general wards is that associated to the use of venous catheter, central and peripheral ones, therefore recommendations for catheterization and maintenance of venous catheters should be implemented. (AU)