Short reportSurveillance programme for multidrug-resistant bacteria in healthcare-associated infections: an urban perspective in South Brazil
Introduction
Healthcare-associated infections (HCAIs) have higher impact in countries where the increasing number and complexity of hospitalized patients coexist with limited public health resources. In this setting, the emergence of multidrug-resistant bacteria (MDRB) may contribute to higher morbidity and healthcare costs. National or regional programmes to support hospitals in reducing HCAIs are recommended.
In Brazil, epidemiological data for MDRB in HCAIs are from individual hospitals or multicentre study groups.1, 2 Prevalence of bacteria in bloodstream infections (BSI) has been surveyed nationally and by the São Paulo State Department of Health.3, 4 National or regional data for MDRB in HCAIs elsewhere are not available.
Based on the need for local data, a surveillance programme for MDRB in HCAIs was developed by the City Health Department (CHD) of Curitiba, a city with about 2 million inhabitants (4 million inhabitants in the metropolitan area). This report describes the results of the surveillance programme.
Section snippets
Methods
The HCAI control division of Curitiba’s CHD has surveyed surgical site infection (SSI) and device-associated infection (DAI) rates since 2002, following national criteria. The MDRB surveillance programme was implemented in October 2010, focusing on facilities with intensive care unit (ICU) beds.
Diagnostic criteria of MDRB in HCAIs and reporting methods were discussed with infection control committees (ICCs) who agreed to notify MDRB in SSI, BSI, pneumonia and urinary tract infection (UTI)
Participating facilities
From the 26 notifying hospitals, eight were teaching hospitals, 14 had more than one UCI and four had only neonatal ICU. These facilities harbour 4443 beds and 710 are ICU beds. Most (64.3%) of the beds serve the public healthcare system.
All the facilities delivered notifications in every month of the study period.
In 2010 there were 266,341 admissions, 8254 HCAIs, of which 2229 were due to MDRB (27%). From January to June 2011, there were 137,928 admissions, 4149 HCAIs, of which 1321 MDRB
Discussion
This is the first report of MDRB prevalence in BSI and other HCAI sites from an urban perspective in Brazil.
From MDRB isolates in BSI of previously described databases, MRSA accounted for >30% and CR-AB for <20%, which shows higher frequency of MRSA and a lower frequency of CR-AB than Curitiba’s data.3, 4 The present data show a higher frequency of MDRB, with more Gram-negative rods (GNRs) than the 2008 CDC report, whose surveillance method limits reports to DAI.5 In agreement with the present
Acknowledgements
We thank the WGHAI participants for their ongoing efforts to monitor infections and improve patient safety, and our colleagues from Curitiba’s Municipal Health Department for their support of this unique public health network.
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