ISSN 2175-5361 DOI: 10.9789/2175-5361.

2013v5n6Esp2p224

Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...

RESEARCH

Sensitivity of embryos related to the pneumonia associated with the ventilation mechanics
Sensibilidade de germes relacionados à pneumonia associada à ventilação mecânica
Sensibilidad de gérmenes relacionados con la neumonía asociada a la ventilación mecánica

Odinéa Maria Amorim Batista1, Marianna Sampaio Gallas Santos2, Francisco Eugênio Deusdará de Alexandria 3, Maria
Zélia de Araújo Madeira4 ,Andréia Rodrigues Moura da Costa Valle5, Alvaro Francisco Lopes de Sousa 6

ABSTRACT
Objective: To analyze the prevalence of germs related pneumonia associated with mechanical ventilation and their
sensitivities profiles. Methods: descriptive epidemiological study, with a quantitative approach. The sample consisted
of 99 patients using mechanical ventilation in two intensive care units in a public and teaching hospital in the
municipality of Teresina-Piauí. The data were collected by means of a form in the months of January and February
2009, statistically processed and presented in the form of tables. Results: The most prevalent pathogens were:
Klebsiella spp (40.40%); Bacillus Gram-Negativo non-fermentor (24.24%); Staphylococcus aureus and pseudomonas
aeruginosa (17.17%). There was a higher bacterial susceptibility to imipenem (76.77%), meropenem (72.73%) and
cefepime (58.59%). Conclusion: Appropriate therapy and prevention strategies reduce the prevalence rates of
pneumonia associated with mechanical ventilation and the emergence of microbial resistance. Descriptors: Nosocomial
infection, Pneumonia, Prevalence, Microbial Sensitivity tests.

RESUMO
Objetivo: Analisar a prevalência dos germes relacionados às pneumonias associadas à ventilação mecânica e seus perfis
de sensibilidades. Métodos: estudo epidemiológico, descritivo com abordagem quantitativa. A amostra constou de 99
pacientes em uso de ventilação mecânica em duas unidades de terapia intensiva em um hospital público e de ensino do
município de Teresina-Piauí. Os dados foram coletados por meio de um formulário nos meses de janeiro e fevereiro de
2009, processados estatisticamente e apresentados em forma de tabelas. Resultados: Os germes mais prevalentes
foram: klebsiella spp (40,40%); Bacilo Gram-Negativo não fermentador (24,24%); Staphylococcus aureus e pseudomonas
aeruginosa (17,17%). Evidenciou-se maior sensibilidade bacteriana ao imipenem (76,77%); meropenem (72,73%) e
cefepime (58,59%). Conclusão: Terapêutica adequada e estratégias de prevenção reduzem as taxas de prevalência de
pneumonia associada à ventilação mecânica e o surgimento de resistência microbiana. Descritores: Infecção
hospitalar, Pneumonia, Prevalência, Testes de sensibilidade microbiana.

RESUMEN
Objetivo: Analizar la prevalencia de gérmenes relacionados con la neumonía asociada a la ventilación mecánica y los
perfiles de sensibilidad. Métodos: enfoque cuantitativo epidemiológico, descriptivo. La muestra estuvo constituida por
99 pacientes con ventilación mecánica en dos unidades de cuidados intensivos de un hospital público y de enseñanza en
la ciudad de Teresina, Piauí. Los datos fueron recolectados a través de un formulario en los meses de enero y febrero
de 2009, estadísticamente procesados y presentados en tablas. Resultados: Los gérmenes más prevalentes fueron:
Klebsiella spp (40,40%), Bacilo Gram-Negativo no fermentador (24,24%), Staphylococcus aureus y Pseudomonas
aeruginosa (17,17%). Fue evidente una mayor sensibilidad bacteriana a imipenem (76,77%), meropenem (72,73%) y
cefepima (58,59%). Conclusión: tratamiento adecuado y las estrategias de prevención de reducir la prevalencia de la
neumonía asociada a ventilación mecánica y el surgimiento de la resistencia microbiana. Descriptores: Infección
nosocomial, Neumonía, Prevalencia, Pruebas de sensibilidad microbiana.

1
Nurse, Master's in Nursing, Federal University of Piauí (UFPI), Professor, Department of Nursing UFPI, Teresina-PI, [email protected]
2
Nurse, Teresina-PI, [email protected]
3
Doctor, infectologist, Master's in Genetics and Toxicology Applied by Applied by the Lutheran University of Brazil (ULBRA),
Professor and Coordinator of the discipline of Infectious Disease, University Center UNI NOVAFAPI, Teresina – PI,
[email protected]
4
Nurse at the hospital Getúlio Vargas, PhD in Medical Sciences from the State University of Campinas (UNICAMP), Master's in
Education UFPI, Professor, Department of Nursing, Federal University of Piauí (UFPI) and of the University Center UNINOVAFAPI,
Teresina – PI, [email protected]
5
PhD in Nursing,, Teresina – PI, [email protected]
6
Undergraduate in Nursing at UFPI, Scientific Initiation Scholarship CNPq(PIBIC). Teresina – PI, [email protected]

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ventilator devices, such as the endotracheal or
INTRODUCTION
nasotracheal (TOT) tube and the tracheotomy, tube
(TQT) does not allow the patient to maintain the
Nosocomial Infection (NI) represents a defense mechanisms of the airways effective, for
public health problem, with a view that a portion example, filtration and humidification of the inspired
of the population is affected by infections acquired air, stimulating the production of secretions. Then
in health institutions. This influences the increased there is the necessity of the removal of secretions by
morbidity and mortality, from direct and indirect nursing staff by means of aspiration 5.
costs, assuming the consequences of human, social Among the various types of pneumonia, is
and economic impact. Mechanical ventilation in most often in the ICU Ventilator-Associated
association with pneumonia is considered a Pneumonia (VAP), which is one that arises 48-72
nosocomial infection and is considered very hours after endotracheal intubation and institution
common in intensive care, with prevalence rates of invasive MV. Similarly, VAP is also classified as
ranging from 6 to 50 cases per 100 admissions to early and late, being early that occurs within four
1-2
the intensive care unit . days of intubation (OTI) and start the MV, and VAP
In Brazil, the nosocomial infection rates late that starts after the fifth day under the same
remain high, i.e. 15.5%, which corresponds to 1.18 conditions.6
episodes of infection per client admitted in One of the methods used to identify and
hospitals, despite the existence of legislation for treat infections related to the lower respiratory
the appointment of the Infection Control tract in a hospital environment is sequential
Committee. Decree no. 2,616 /1998 conceptualizes monitoring of the tracheal secretions in intubated
nosocomial infection (NI) that which is acquired patients in the ICU environment.7
after the patient's admission and that manifests The tracheal secretion cultures are used to
itself during the hospitalization or after discharge, reflect on the local colonization of microorganisms.
when it can be related with the hospitalization or Since the bronchoalveolar lavage (BAL) is used as a
3-4
hospital procedures. diagnostic for VAP in immune-compromised
The Intensive Care Units (ICUs) constitute patients, and is considered the most reliable
service levels the health of high complexity, acting method towards microbiological investigation of
decisively when there is instability of organs and the lower respiratory tract, thereby increasing the
functional systems with risk of death. Thus, the chances of success by treatment with
8.
admitted patients in ICUs are subject to risks of 5 antimicrobials.
to 10 times greater for acquiring infection other The incorrect use of antimicrobial agents is an
than those in hospitalization units of the hospital, important factor in the pathogenesis of pneumonia,
because they are more exposed to risk factors such often by resistant bacteria. The strategies for
as invasive procedures, complex surgeries, prevention of Pneumonia Acquired in Hospital (PAH)
immunosuppression drugs, antimicrobial agents and and VAP may reduce the morbidity, mortality, and
the interactions with the healthcare team and costs 6.
fomites.3 Thus, this study aimed to analyze the
The professionals of the nursing team are prevalence of germs related Pneumonia Associated
beside the patient 24 hours of the day, therefore, with Mechanical Ventilation in Intensive Care Units
active participants of therapy implemented since of a teaching hospital and their profiles of
they provide monitoring and continuous assistance. sensitivities.
The invasive ventilator support by means of
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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
The research was carried out in accordance
METHODOLOGY with the recommendations contained in the
Resolution 196/96 of the National Health Council,
Descriptive, retrospective epidemiological which brings together the ethical aspects of
Study with quantitative approach performed in research involving human beings and after
Intensive Care Units (I and II) of a teaching authorization of the Ethics and Research
hospital. For carrying out this study, we have Committee (CEP) of the Faculty of Higher
selected a hospital of the public network, located Education and Technological of Piauí - NOVAFAPI
in the municipality of Teresina - PI, by the fact with approval number of the CAAE 0245.0.043.000
that the same be a large hospital and be of -09.
reference in the whole State of Piaui and
RESULTS AND DISCUSSION
neighboring states with exclusive service by Unified
Health System (SUS).
The population was composed of adult The results of this study demonstrate the
patients hospitalized in Intensive Care Units (I and prevalence and the profiles of sensitivities of
II) of this hospital (N= 499). As it is a finite germs related pneumonia associated with
population and an epidemiological study, the mechanical ventilation in patients hospitalized in
sample (n= 99) consisted of patients hospitalized in ICUs I and II of a public teaching hospital.
two ICUs this teaching hospital in use of MV, from By comparing this study with other authors,
48 hours ago, with isolated positive culture of it was observed that the agents that most
tracheal secretions. frequently cause nosocomial pneumonia could vary
The inclusion criteria were patients greatly, according to the geographic region.
hospitalized in ICUs (I and II) in the period 1 Among all the NI, pneumonia is considered
January to 31 December of the year of 2008 that worrisome for multidisciplinary health team, its
used invasive MV and had positive culture for severity, and these in turn raised rates in an
pneumonia from 48 hours of MV. The following indirect measure of the quality of care received by
patients were excluded in use of MV that had users in this health institution because immune-
isolated negative tracheal secretion, records and compromised patients have predisposed to this
results of examinations not located. type of infection.
We used a form for data collection. The The pneumonias are responsible for 15% of
data were collected in the months of January and infections related to health care and approximately
February 2009 and processed by means of the 25% of all infections acquired in Intensive Care
program Statistical Product and Service Solutions - Units. The majority of these infections is
SPSS 16.0, presented in the form of tables and associated with the MV and there are larger
statistically analyzed. epidemiological indices on this type of pneumonia
We used selection census in all patients acquired in the hospital environment. Data from
hospitalized in 2008, through the database of the the State of Sao Paulo in 2008 showed that the
Commission of Infection Control (CCIH), median incidence of Pneumonia Associated with
annotations and high admissions filed in the Mechanical Ventilation (VAP) was 16.25 cases per
Registry of Intensive Care Units, and records the 1,000 days of ventilator usage in adult ICUs.10
Statistical Service Medical Records (SAME) teaching The prevalence of pneumonia in two ICUs
hospital. analyzed was 42.89%. The ICU II was responsible for
the higher rate of respiratory infection, 54.55%,
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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
while the ICU I had a prevalence of 45.45%, which
is worrying, because it demonstrates a high index
of these infections, when compared to national
result (20.3%)11. The study found that the average
time of hospitalization of patients in ICUs I and II
was 27.64 days. Since the average time of use of
mechanical ventilator was 20 days.
These pneumonias are directly associated
with the risk factors to which they are exposed.
The occurrence of pneumonia in critical patients
hospitalized in orotracheal intubation and
mechanical ventilator, considered risk factors.
Table 1 represents the prevalence of
microorganisms isolated in ICUs I and II, these
microorganisms causing pneumonia in these Units
are: Klebsiella spp. (40,40%), Gram-Negative
Bacillus (GNB) non-fermentor (24.24%),
Table 3 shows the sensitivity of the
Pseudomonas aeruginosa (17.17%), Staphylococcus
microorganisms found in the study, to the
aureus (17.17%), Proteus spp. (2.02%) and E. coli
antibimicrobianos used in ICUs I and II of the public
(1.01%), being the first four those responsible for
teaching hospital. It shows the predominance of
greater numbers of cases.
the sensitivity of the microorganism Pseudomonas
aeruginosa to amikacin (88.24%), Staphylococcus
aureus to ciprofloxacin, oxacillin and rifampin
(70.59%), BGN non-fermentor to imipenem
(95.45%), and Klebsiella pneumoniae to imipenem
(92.50%) and meropenem (90%).
In the study it was observed that the
problem of nosocomial infection (NI) in this
scenario presents serious proven from the high
prevalence rate of pneumonia which reflects the
quality of care provided to users of this health
Table 2 represents the sensitivity of institution.
microorganisms to antimicrobial agents used in The diagnosis of nosocomial pneumonia
ICUs I and II. It was evident in antibiograms, presents many difficulties, especially in patients on
greater bacterial sensitivity to antimicrobial mechanical ventilation. In practice, this diagnosis
imipenem, with 76.77%, followed by meropenem, is based on clinical and radiological criteria, being
with 72.73%, with 58.59% of cefepime and emphasized by the presence of fever, purulent
amikacin, with 52.53%, and this sensitivity sputum, signs of pulmonary consolidation and new
dependent on the isolated microorganism. or progressive infiltrate to the X ray 9
In tracheal secretion collection for
microbiological examination in intubated patients,
by means of aspiration probe the results of these

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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
samples may reflect local colonization, being the respiratory site has been implicated in source of
extremely complicated clinical interpretation. As the infectious process, which is compatible with an
procedure for etiologic diagnosis of nosocomial increase in the number of patients under
pneumonia, this procedure is not recommend, mechanical ventilation and with prolonged
which may lead to inappropriate therapeutic hospitalization in ICUs. The results corroborate
8
approaches. with the literature, since there is a high rate of
infection among patients in intensive care,
especially in respiratory infections whose prevalent
bacteria were gram-negative: Klebsiella
pneumoniae, Pseudomonas aeruginosa and
Staphylococcus aureus methicillin resistant (MRSA).
About 70% of these microorganisms have VAP in
their etiology.4,13,14
The treatment of infections caused by BGN
non-fermentor are almost uniformly susceptible to
combinations as ampicillin-sulbactam, piperacillin-
tazobactam or also to imipenem and meropenem.
Other antimicrobials that can submit activity
against these bacilli are, levofloxacin, and
13
moxifloxacin tobramicinacom cefepime.
The Klebsiella spp. is an Enterobacter of
the gram-negative bacilli family, also it is a
frequent cause of infections associated with health
treatment such as pneumonia acquired in the
hospital. These infections are much more difficult
to deal with, because the Klebsiella spp strains are
Patients on MV are likely to suffer resistant. Some useful agents for combating this
inoculation of microorganisms by aspiration or by enterobacteria (except beta-lactamase-producing
aerosols. Approximately 33% of ventilator circuits Extended Spectrum - ESBL) include third-
are contaminated with the flora of the oropharynx generation cephalosporins such as cefotaxime,
of the patient after two hours of use, 64% within 12 ceftriaxone, ceftizoxime, also include
hours and 80% at the end of 24 hours. Simple carbapenems like imipenem, meropenem and
procedures such as changing positions or raise the ertapenem (acting on these ESBL-producing
head of the bed of the patient may cause the strains). 13

passage of contaminated liquid into the respiratory The Pseudomonas aeruginosas are also
tract. Some authors recommend changing the gram-negative bacilli found in the environment and
8.
ventilator circuit every 48 hours it is a frequent cause of nosocomial infection,
In daily practice performed by a particularly pneumonia. With response to
professional emergency physician is the realization resistance strains of Pseudomonas aeruginosa,
of the early intubation and invasive mechanical often are not susceptible to one or more
ventilation (IMV); however, the patient often antibiotics, such as for example recent analyzes
remains in IMV mainly by the difficulty in indicate that 15 to 25% of strains are resistant to
availability of ICU beds. Increasingly the piperacillin; 20 to 30% to ceftazidime and 40 to 45%
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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
to aztreonam. Thus, no antibiotic regimen is cephalosporin, preserves the action on gram-
effective against P. aeruginosa, so the treatment negative bacteria, including antipseudomonal
should be directed by profiles of individual activity, in addition to show activity against gram-
susceptibility of strains.13 positive cocci, especially oxacillin-susceptible
A review of the history of attempts to treat staphylococci.15
infections caused by S. aureus shows the ability of The rates of VAP can vary according to the
the bacterium to overcome our greatest efforts in population of patients and the available diagnostic
containment of antimicrobial resistance. In the methods. The various studies show that the
1940s and 1950s, infections caused by S. aureus incidence of this infection increases with the
were treated with penicillin; however, this duration of MV and point attack rates of
microorganism soon developed resistance to the approximately 3% per day during the first five days
cited antimicrobial. Over the years new of ventilation and then 2% for each subsequent
antimicrobial studies were identified as day. The impact of this infection is reflected in the
antiestafilocóccicas penicillins, cephalosporins, extension of the hospitalization, at around 12 days
carbapenems and vancomycin, which were and in the increase of costs, around 40000 dollars
effective in solving infections caused by S. aureus, per episode 10.
however, the use of these drugs did not prevent The advent of antibiotics and
the emergence of resistant strains. The chemotherapeutics allows control and cure of
antimicrobials, such as clindamycin, ciprofloxacin, various infectious diseases. However, with the
clarithromycin and azithromycin in certain emergence of bacterial resistance of some species,
infectious processes proved to be effective against this has become a problem at the time of the
S. aureus.13 choice of the treatment to the client. In This way,
The antimicrobials imipenem, meropenem the antibiotics represent a high consumption inside
and ertapenem are carbapenems currently the hospitals, in particular in the ICUs, where are
available in clinical practice in the US, Europe and the critical patients. The abusive use of antibiotics
Brazil. Exhibit broad spectrum of action for use in and the lack of criteria for the choice of empirical
systemic infections and are stable in the majority treatment are determining factors for the
of ß- lactamases. Meropenem is a little more active emergence of various microorganisms resistant in
against gram-negative bacteria, while imipenem intensive care units 3.12.
activity presents a little higher than against gram- Oxacillin is an isoxazolilpenicilina, semi-
positive. Due to the discrete differences, with synthetic derivative of penicillin G, is indicated for
respect to the mechanism of resistance, can be the treatment of infections caused by methicillin-
found sensitive samples to a carbapenem and susceptible staphylococci regardless of the severity
resistant to others. This phenomenon is relatively of the infection. It is important to emphasize the
rare and related to resistance mechanism that empirical use of vancomycin for treatment of
involves the porinas, but has been described nosocomial infections, due to the increasing
mainly in strains of Pseudomonas aeruginosa.15 incidence of oxacillin resistant Staphylococcus
Regarding amikacin, it has the greatest aureus (ORSA). It is observed that in most hospitals
action spectrum from the aminoglycosides group the empirical treatment of staphylococcal
and is used in infections caused by gram-negative infections usually with vancomycin or teicoplanin
bacilli resistant to gentamicin and empirical (with glycopeptides), however, if there is
therapy of infections related to healthcare. confirmation of the etiology of infection by
Cefepime, which is a fourth-generation Staphylococcus aureus sensitive to oxacillin is
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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
rational exchange for this antibiotic in order to (58.82%), followed by Pseudomonas aeruginosa
optimize power and minimize the impact related to (41.18%), BGN non-fermentor (22.73%) and
toxicity, selection of resistance and costs.16 Klebsiella spp (17.50%). E. coli and Proteus sp.
As shown in table 3, the best indication of showed no sensitivity to gentamicin as shown in
oxacillin corresponds to Staphylococcus aureus table 3.
(70.59%); however, the vancomycin still possesses a The RIF is endowed with antibiotic activity
greater sensitivity, with a percentage of 82.35%. against various microorganisms by exerting its
There are reports in the literature that the antimicrobial activity to inhibit the RNA-dependent
vancomycin is one of the antimicrobial agents that polymerase of deoxyribonucleic acid (DNA).
can be used for the treatment of severe infections, Rifampicin is only available in Brazil for oral use. It
such as pneumonia, caused by strains of is active against many bacteria, among them,
Staphylococcus aureus resistant to oxalina. We Staphylococcus aureus19. According to table III, the
emphasize that in our study the Staphylococcus study demonstrated that the antibiotic rifampicin
aureus was not 100% sensitivity to vancomycin due showed sensitivity, among the six species
16
to not testing of two cases among the 17 found. prevalent, only to Staphylococcus aureus with a
It should also be observed in table 3 that percentage of 70.59%.
the cefepime has a higher activity against The in vitro activity of imipenem is
Pseudomonas aeruginosa (70.59%). As the excellent for a wide variety of aerobic
literature shows, this was mainly due to its greater microorganisms and anerobicos. It is indicated for
resistance to beta-lactamase inhibitor, due to the treatment of urinary tract infections, lower
cephalosporins of "fourth generation" (cefepime), respiratory tract infections, intra-abdominal and
when introduced into medical practice, have a gynecological, skin, soft tissues, bones and joints.18
higher activity than the cephalosporins of "third S. aureus is considered an opportunistic
generation".16 human pathogen and is frequently associated with
The use of amikacin is recommended only nosocomial infections. In Brazil, the NI caused by
for the treatment of severe infections caused by methicillin-resistant S. aureus, is also high,
19
sensitive bacteria in cases of sepsis, pneumonia corresponding to 40% to 80%, mainly in ICUs.
and other serious infections of compromising the Infection by Pseudomonas spp. is
general status of the patient, most often in opportunistic; the existence of breaking barriers or
association with other antimicrobial agents. The specific defects in some of the mechanisms of
percentage of strains of Pseudomonas aeruginosa immune defense and in contact with the man being
resistant to amikacin tends to be lower than that necessary and may colonize different tissues.
observed in relation to gentamicin and tobramycin, Among the most prevalent manifestations is
20
because this antibiotic is sensitive to smaller pneumonia.
number of enzymes inactivating mutations of Klebsiella pneumoniae is an important
aminoglycosides produced by Gram-negative causative pathogen in nosocomial infections,
bacilli.16-17 especially in units of critical patient treatment as
The gentamicin is the aminoglycoside in ICUs. The resistance of beta-lactamase-
endowed with greater potential synergistic with producing Klebsiella pneumoniae extended-
betalactam antibiotics and with vancomycin for the spectrum (ESBL), class of enzymes that confer
treatment of infections caused by streptococci and resistance to all cephalosporins, cause concern in
19
enterococci. In this study the gentamicin showed intensive care services. A rate of 20% of Klebsiella
a higher sensitivity to Staphylococcus aureus pneumonia are resistant to all penicillin,
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Batista OMA, Santos MSG, Alexandria FED et al. Sensitivity of embryos related...
cefotaximas, cefetriaxon, aztreonam, but are not It revealed that rates of nosocomial
resistant to carbapenicos (imipenem), since they infection as well as multiressistência to the
have greater stability.3,19 antimicrobial drugs are high. This is also due to the
Studies show that the importance of gram- large-scale use of antimicrobials in the ICUs
negative bacilli non-fermentors in the hospital has surveyed. The rate of respiratory infections in two
increased rapidly in recent years, and its high rate ICUs was 42.89%. It was observed that the
of insulation may be due to the high use of microorganisms isolated in this study and their
antibiotics and/or failures in the implementation susceptibility profiles are in accordance with the
of control measures for hospital infection the studies carried out in this area.
evaluated institutions. It also confirmed that, once In ICUs, there are several predisposing
entered in the hospital, its eradication becomes factors for the development of NI as in prolonged
difficult and dissemination may occur quickly and hospitalization time, use of mechanical ventilation,
widely.21 invasive procedures, advanced age, among others.
Thus, the micro-organisms S. aureus, There is a need for continued monitoring on the
Pseudomonas spp., Klebsiella pneumoniae and BGN part of the Commission of Hospital Infection
non-fermentor are part of the microbial flora of Control (CCIH) in hospital, as recommended by the
the investigated hospital ICUs, demonstrating National Program of Hospital Infection Control from
sensitivity to antimicrobial agents and standardized the Ministry of Health (MOH).
some of restricted use, requiringmonitoring on the The norms for the prevention and control of
part of the CCIH of the hospital. Thus, the micro- nosocomial infections advocates: the practice of
organisms S. aureus, Pseudomonas spp., Klebsiella proper hand hygiene, the adoption of standard
pneumoniae and BGN non-fermentor are part of precaution, identification and monitoring of multi-
the microbial flora of the investigated hospital resistant bacteria, appropriate antibiotic therapy,
ICUs, demonstrating sensitivity to antimicrobial environmental hygiene and training of the
agents and standardized some of restricted use, multidisciplinary team, as important factors that
requiringmonitoring on the part of the CCIH of the may affect the results for the reduction of
hospital. The control of antimicrobial agents prevalence of NI.
depends on a better quality in antibiotic therapy, Finally, the result of this study is of the
and a reduction in the intensity of the spread of utmost importance for the clarification of health
resistance, thus minimizing the non-rational use of professionals that deal, both directly and
16,22
antimicrobials. indirectly, with patients in Intensive Care Units.
Confirming that, through proper choice of therapy
Embora se CONCLUSION
trate ainda de uma realidade used as well as prevention strategies, it potentially
decreases the incidence of VAP, the emergence of
The most prevalent microorganism was microbial resistance, and reduce morbidity,
Klebsiella spp. (40.40%), followed by BGN not mortality and hospital costs.
fermentor (24.24%), Staphylococcus aureus and
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Received on: 09/04/2013

Required for review: no
Approved on: 25/10/2013
Published on: 27/12/2013

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