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Review
. 2014:2014:480463.
doi: 10.1155/2014/480463. Epub 2014 Nov 27.

Gram-negative infections in adult intensive care units of latin america and the Caribbean

Carlos M Luna  1 , Eduardo Rodriguez-Noriega  2 , Luis Bavestrello  3 , Manuel Guzmán-Blanco  4
Affiliations
Review

Gram-negative infections in adult intensive care units of latin america and the Caribbean

Carlos M Luna et al. Crit Care Res Pract. 2014.

Abstract

This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor for resistance development and excessive mortality. Infection control strategies utilizing hygiene measures and antimicrobial stewardship programs reduced the rate of device-associated infections. To mitigate the poor health outcomes associated with infections by multidrug-resistant Gram-negative bacteria, urgent focus must be placed on infection control strategies and local surveillance programs.

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Figures

Figure 1
Figure 1
Frequency of Gram-negative bacteria (all n/N) among bacteriologically documented infections in (a) Latin American and Caribbean ICUs and (b) Brazilian ICUs specifically [–, , –36, 42, 66]. VAP: ventilator-associated pneumonia, CAUTI: catheter-associated urinary tract infection, CLABSI: central line-associated bloodstream infection, HAI: hospital-acquired infection, BSI: bloodstream infection, and ICU: intensive care unit.
Figure 2
Figure 2
Resistant Gram-negative bacilli. Resistance profile of Gram-negative bacilli isolated from adult intensive care patients who participated in Argentina's National Surveillance of Hospital Infections Program in 2004 and 2005 [16].
Figure 3
Figure 3
Gram-negative organisms (Chilean ICUs). The proportion of susceptible A. baumannii (n = 159), P. aeruginosa (n = 173), and K. pneumoniae (n = 135) isolates collected from all 31 hospitals [34]. CAUTI: catheter-associated urinary tract infection, VAP: ventilator-associated pneumonia, CLABSI: central line-associated bloodstream infection, and ICU: intensive care unit.
Figure 4
Figure 4
Gram-negative organisms (Venezuelan intensive care units). Susceptibility of Gram-negative bacilli isolated from adult intensive care patients who participated in the Venezuelan Surveillance Program on Antimicrobial Resistance [16].
See this image and copyright information in PMC

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