Infecção do trato urinário em pacientes com cateter vesical nas unidades de terapia intensiva de um hospital universitário

O objetivo deste estudo foi analisar a infecção do trato urinário relacionada ao cateterismo vesical de demora (CVD) em pacientes adultos internados nas unidades de terapia intensiva (UTIs) de um hospital universitário. Estudo de coorte, prospectivo, com abordagem quantitativa, tendo sido investigados 394 adultos internados no período de abril a dezembro de 2011. Todos os pacientes com CVD foram avaliados diariamente durante o tempo de permanência nas UTIs e o tempo de uso do cateter. Foram pesquisadas variáveis relacionadas ao paciente, ao CVD e à infecção. Para tabulação e análise dos dados utilizou-se o programa estatístico SPSS,versão15.0, obtendo-se frequências absolutas e percentuais. Foram aplicados os testes qui-quadrado de Pearson e exato de Fisher, considerando-se um nível de significância de 5%. Para os procedimentos de análise, os pacientes foram divididos em dois grupos, um composto por 137 pacientes com infecção do trato urinário relacionada ao cateter (ITU-RC) e outro com 257 pacientes sem ITU-RC. A taxa de ITU-RC observada foi de 34,8%. A diarreia, o tempo de permanência do cateter e a admissão no serviço com CVD foram fatores determinantes da ITU-RC (p< 0,05).Os microrganismos mais presentes nas uroculturas foram Candida (64,9%), Acinetobacter (14,6%) e Pseudomonas (13,1%). Dos pacientes com ITU-RC, 24,1% apresentaram microrganismos multirresistentes aos antimicrobianos no sítio urinário. As espécies que mais desenvolveram resistência aos antimicrobianos foram produtoras de carbapenemases, tendo Acinetobacter baumannii apresentado 20,8% de amostras resistentes, Pseudomonas aeruginosa 16,6% e Klebsiella pneumoniae 16,2%. Dentre os pacientes com ITU-RC, 2,2% desenvolveram sepse de foco urinário. A prescrição de cuidados de enfermagem para o cateterismo vesical foi considerada insuficiente. Há necessidade de ações mais efetivas dos enfermeiros e demais profissionais da equipe de saúde na tentativa de controlar as ITU-RC, diminuindo custos e melhorando a qualidade da assistência.The purpose of the research was to analyze the occurence of Catheter-Associated Urinary Tract Infection (CAUTI) in adult patients admitted to the intensive care units (ICUs) of a university hospital. It was realized a quantitative prospective cohort study, and it was investigated 394 adult patients hospitalized from April to December 2011. All patients with indwelling urinary catheters were evaluated daily by an investigator during the length of stay in the ICUs and the length of time the catheter remained in place. Variables were researched related to the patient, the indwelling urinary catheter and the CAUTI. Statistical analysis were performed using SPSS (Statiscal Package for Social Sciences) 15.0 version. This research mainly observed absolute frequencies and percentage. Data analysis was done using Chi-square test and Fishers exact test, it was considered a significance level of 5% in these tests. To realize the analysis procedures, patients were divided in two groups, one composed of 137 patients who were catheterizated and developed CAUTI, and another group was composed of 257 patients that were catheterizated but did not developed CAUTI. The rate of CAUTI was 34,8%. In group of patients with CAUTI the factors that showed the high level significance for development of this infection were diarrhea, the time of urinary catheterization, and when the patient was admitted in this hospital with an urinary catheter that was introduced in another heath service. The most common microorganisms that were present in the urine cultures were Candida (64,9%), Acinetobacter (14,6%) and Pseudomonas (13,1%). Of the patients with CAUTI, 24,1% were considered with antimicrobial-resistant pathogens in urinary site. The species which most developed antimicrobial resistance were the species producer of carbapenemases, and Acinetobacter baumannii showed 20,8%of resistant samples, Pseudomonas aeruginosa 16,6%, and Klebsiella pneumoniae, 16,2%. Among patients with CAUTI, 2,2% developed urosepsis.The nursing care for catheterizated patients were considered insufficient in nursing annotations. There is need for more effective actions of the nurses and other professionals that are working together in these intensive care units to control CAUTI. The control of CAUTI should be able to reduce costs and improve the quality of the care to patients that need to use an indwelling urinary catheter