Study of mediastinitis by carbapenem-resistant Enterobacteriaceae in the patient post cardiac surgery: analysis of clinical, epidemiological, microbiological and molecular aspects in a period of five years (2009-2014)

Abstract

The emergence of resistant organisms in the hospital environment in recent decades has been a worldwide topic of great interest and concern reality, considering the use of antibiotics indiscriminately and lack of new antimicrobials on the market that can meet the growing demand of bacterial resistance. The emergence of Klebsiella pneumoniae producing the carbapenemase enzyme (KPC) and later, the detection of this enzyme in different genera of Gram-negative bacteria, especially among Enterobacteriaceae resistant to Carbapenems (ERC) has contributed significantly to the alarming global overview of this resistance mechanism. In this scenario, the rapid spread of ERC in hospital environments, high resistance to available antimicrobials and the increasing mortality rate described in cases of patients infected by these organisms has been the subject of studies aimed at better understanding the clinical and microbiological pathogens.Our goal with this study is: (i) develop an epidemiological study of infection by ERC through validation of a spatio-temporal model, considered an innovation in hospital epidemiology, since this model has only been tested in cases of outbreaks in the community (ii) assess the risk factors for patients undergoing cardiac surgery with development of mediastinitis ERC through a case-control case, as described in the methodology of the project and (iii) conduct a microbiological and molecular investigation of resistance mechanisms expressed in all clinical isolates of ERC, highlighting the constant changes of resistance profile during the five year period of the study. For this purpose is being fitted with a bank of microorganisms ERC strains recovered from patients who were registered in a database of clinical and epidemiological data from the Instituto Dante Pazzanese de Cardiologia. The outbreak investigation will be conducted by ERC through a spatio-temporal model, especially designed for this study, which will evaluate the non-Euclidean in a nearby hospital. This study will elucidate issues relating to resistance mechanisms and therapeutic possibilities in cases of ERC focusing on mediastinitis after cardiac surgery. A thorough analysis of this population will be of great benefit to the knowledge of all clinical, epidemiological and molecular evolution of infection by ERC in a public institution focused on high complexity care, teaching and research in the city of São Paulo, and serving patients from serious from all Brazilian regions. (AU)