Desinfecção por Vapor de Peróxido de Hidrogênio no Transplante de Fígado: Efeitos na Colonização de Organismos Multirresistentes e nos Resultados do Receptor
Palavras-chave:
Transplante de Fígado, Organismos Multirresistentes, Infecções Associadas aos Cuidados de Saúde, Contaminação AmbientalResumo
Introdução: A escalada das infecções por organismos multirresistentes (MR) pós-transplante de fígado (TF) representa riscos significativos, com a colonização por MR amplificando a suscetibilidade à infecção. A desinfecção ambiental é crucial para conter as infecções associadas à assistência à saúde (IRAS). A tecnologia de vapor de peróxido de hidrogênio (VPH) oferece promessas, mas seu impacto nas infecções por MR e nos resultados dos pacientes ainda não está claro. Métodos: Um estudo de coorte incluiu 58 receptores de TF adultos, comparando os resultados antes e depois da implementação rotineira do VPH. A desinfecção por VPH seguiu a limpeza terminal em salas cirúrgicas e boxes de unidade de terapia intensiva. Os dados dos patógenos incluíram colonização por MR no pré- e pós-transplante. Os dados clínicos abrangeram características dos receptores, gravidade da doença e características do binômio doador-receptor. As análises estatísticas avaliaram associações e resultados. Resultados: Vinte e sete pacientes estavam no grupo antes do VPH e 24 no grupo após o VPH. As características demográficas e clínicas foram comparáveis entre os grupos. A implementação do VPH aumentou significativamente a probabilidade de resultados negativos nos swabs de controle (razão de chances 2,33). Klebsiella pneumoniae carbapenemase foi o patógeno mais frequente, com infecções do sítio cirúrgico sendo o local primário mais comum. Pacientes com swabs negativos tiveram internações hospitalares mais curtas (diferença média de 10,54 dias), divergindo notadamente por volta do 8o dia de internação. A frequência de IRAS e a mortalidade em 90 dias foram significativamente menores em pacientes com swabs negativos. Conclusão: A tecnologia de VPH reduziu efetivamente a colonização por MR em receptores de TF. Swabs negativos se correlacionaram com internações hospitalares mais curtas e menor frequência de IRAS, impactando positivamente a mortalidade em 90 dias. Apesar dos desafios na implementação do VPH, sua eficácia na redução da colonização por MR sugere uma ferramenta valiosa nas estratégias de controle de infecções para populações vulneráveis como receptores de TF.
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Copyright (c) 2024 Fábio Silveira, Fábio Porto Silveira, Csaaia Regina Sbrissia Silveira, Tatiana Luisa Shibata Facchi, Ellen Dalla Costa, Kengi Itinose
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