Estrategias de prevención de infecciones tardías en unidades de cuidados intensivos neonatales

Autores/as

  • Alberto Antonio Toso Milos Pontificia Universidad Católica de Chile
  • María Soledad Urzúa Baquedano Pontificia Universidad Católica de Chile

Palabras clave:

sepsis, infección, prevención, antimicrobial stewardship, bundles, prematurez.

Resumen

Introducción: la sepsis tardía (ST) sigue siendo un problema relevante en las unidades de cuidados intensivos de neonatología (UCIN), especialmente en recién nacidos (RN) menores de 1500 g o RN de muy bajo peso al nacer (RNMBPN). Método: se realizó una búsqueda de la mejor evidencia disponible respecto a las estrategias de prevención de infecciones en unidades de cuidados intensivos neonatales.

Resultados: se han descrito diversas estrategias para intentar disminuir su incidencia, entre estas se incluye el uso de vacunas en el embarazo, profilaxis con fluconazol y uso de probióticos. Han demostrado utilidad otras medidas destinadas a reducir y racionalizar el uso de antibióticos, la creación de equipos especializados y la incorporación de bundles a la práctica clínica. Conclusiones: Este artículo resume la evidencia actualmente disponible y proporciona herramientas que pueden ser utilizadas en la práctica cotidiana dentro de las UCIN.

Biografía del autor/a

Alberto Antonio Toso Milos, Pontificia Universidad Católica de Chile

Médico Neonatólogo, Departamento Neontaología, División de Pediatría, Facultad de medicina, Pontificia Universidad Católica de Chile.

María Soledad Urzúa Baquedano, Pontificia Universidad Católica de Chile

Profesora asistente, Departamento Neontaología, División de Pediatría, Facultad de medicina, Pontificia Universidad Católica de Chile.

Citas

Alexander VN, Northrup V & Bizzarro MJ. (2011). Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 159, 392-397.

Astorga MC, Piscitello KJ, Menda N, Ebert AM, Ebert SC, Porte MA & Kling PJ. (2018). Antibiotic Stewardship in the Neonatal Intensive Care Unit: Effects of an Automatic 48-Hour Antibiotic Stop Order on Antibiotic Use. Journal of the Pediatric Infectious Diseases Society 8, 310-316.

Azab SFA, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM, Siam AG, Arafa MA, Alghobashy AA, Bendary EA, Basset MAA, Ismail SM, Akeel NE, Elsamad NA, Mokhtar WA & Gheith T. (2015). Reducing ventilator-associated pneumonia in neonatal intensive care unit using "VAP prevention Bundle": a cohort study. BMC Infect Dis 15, 314-314.

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK & Trivedi KK. (2016). Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases 62, e51-e77.

Benjamin DK, DeLong ER, Steinbach WJ, Cotton CM, Walsh TJ & Clark RH. (2003). Empirical Therapy for Neonatal Candidemia in Very Low Birth Weight Infants. Pediatrics 112, 543-547.

Benjamin DK, Jr, Hudak ML, Duara S, Randolph DA, Bidegain M, Mundakel GT, Natarajan G, Burchfield DJ, White RD, Shattuck KE, Neu N, Bendel CM, Kim MR, Finer NN, Stewart DL, Arrieta AC, Wade KC, Kaufman DA, Manzoni P, Prather KO, Testoni D, Berezny KY, Smith PB & Team ftFPS. (2014). Effect of Fluconazole Prophylaxis on Candidiasis and Mortality in Premature Infants: A Randomized Clinical TrialFluconazole Prophylaxis, Candidiasis, and MortalityFluconazole Prophylaxis, Candidiasis, and Mortality. JAMA 311, 1742-1749.

Benjamin DK, Stoll BJ, Fanaroff AA, McDonald SA, Oh W, Higgins RD, Duara S, Poole K, Laptook A & Goldberg R. (2006). Neonatal Candidiasis Among Extremely Low Birth Weight Infants: Risk Factors, Mortality Rates, and Neurodevelopmental Outcomes at 18 to 22 Months. Pediatrics 117, 84-92.

Cantey JB & Milstone AM. (2015). Bloodstream Infections: Epidemiology and Resistance. Clinics in Perinatology 42, 1-16.

Chiu C-H, Michelow IC, Cronin J, Ringer SA, Ferris TG & Puopolo KM. (2011). Effectiveness of a Guideline to Reduce Vancomycin Use in the Neonatal Intensive Care Unit. The Pediatric Infectious Disease Journal 30, 273-278.

Clark RH, Bloom BT, Spitzer AR & Gerstmann DR. (2006). Reported Medication Use in the Neonatal Intensive Care Unit: Data From a Large National Data Set. Pediatrics 117, 1979-1987.

Costa RL, Moreira J, Lorenzo A & Lamas CC. (2018). Infectious complications following probiotic ingestion: a potentially underestimated problem? A systematic review of reports and case series. BMC Complementary and Alternative Medicine 18, 329.

Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sánchez PJ, Ambalavanan N & Benjamin DK. (2009). Prolonged Duration of Initial Empirical Antibiotic Treatment Is Associated With Increased Rates of Necrotizing Enterocolitis and Death for Extremely Low Birth Weight Infants. Pediatrics 123, 58-66.

De Man P, Verhoeven BAN, Verbrugh HA, Vos MC & van den Anker JN. (2000). An antibiotic policy to prevent emergence of resistant bacilli. The Lancet 355, 973-978.

Diomedi A, Chacón E, Delpiano L, Hervé B, Jemenao MI, Medel M, Quintanilla M, Riedel G, Tinoco J & Cifuentes M. (2017). Antisépticos y desinfectantes: apuntando al uso racional. Recomendaciones del Comité Consultivo de Infecciones Asociadas a la Atención de Salud, Sociedad Chilena de Infectología. Revista chilena de infectología 34, 156-174.

Dong Y & Speer CP. (2015). Late-onset neonatal sepsis: recent developments. Archives of Disease in Childhood - Fetal and Neonatal Edition 100, F257-F263.

Ehrenkranz NJ & Alfonso BC. (1991). Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters. Infection Control & Hospital Epidemiology 12, 654-662.

Escalante MJ, Ceriani-Cernadas JM, D’Apremont I, Bancalari A, Webb V, Genes L, Villarroel L, Munoz E, Tapia JL & Network ftNN. (2018). Late Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network. The Pediatric Infectious Disease Journal 37, 1022-1027.

ELFIN trial investigators group. (2019). Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial. Lancet 393, 423-433.

Karlowicz MG, Buescher ES & Surka AE. (2000). Fulminant Late-Onset Sepsis in a Neonatal Intensive Care Unit, 1988–1997, and the Impact of Avoiding Empiric Vancomycin Therapy. Pediatrics 106, 1387-1390.

Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M & Donowitz LG. (2001). Fluconazole Prophylaxis against Fungal Colonization and Infection in Preterm Infants. New England Journal of Medicine 345, 1660-1666.

Kuppala VS, Meinzen-Derr J, Morrow AL & Schibler KR. (2011). Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 159, 720-725.

Madhi SA, Cutland CL, Kuwanda L, Weinberg A, Hugo A, Jones S, Adrian PV, van Niekerk N, Treurnicht F, Ortiz JR, Venter M, Violari A, Neuzil KM, Simões EAF, Klugman KP & Nunes MC. (2014). Influenza Vaccination of Pregnant Women and Protection of Their Infants. New England Journal of Medicine 371, 918-931.

Manzoni P, Rinaldi M, Cattani S, Pugni L, Romeo MG, Messner H, Stolfi I, Decembrino L, Laforgia N, Vagnarelli F, Memo L, Bordignon L, Saia OS, Maule M, Gallo E, Mostert M, Magnani C, Quercia M, Bollani L, Pedicino R, Renzullo L, Betta P, Mosca F, Ferrari F, Magaldi R, Stronati M, Farina D, Study ftITFft & Prevention of Neonatal Fungal Infections tISoN. (2009). Bovine Lactoferrin Supplementation for Prevention of Late-Onset Sepsis in Very Low-Birth-Weight Neonates: A Randomized Trial. JAMA 302, 1421-1428.

Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, Tridapalli E, Corona G, Giovannozzi C, Farina D, Arisio R, Merletti F, Maule M, Mosca F, Pedicino R, Stronati M, Mostert M & Gomirato G. (2007). A Multicenter, Randomized Trial of Prophylactic Fluconazole in Preterm Neonates. New England Journal of Medicine 356, 2483-2495.

Pammi M & Abrams SA. (2019). Enteral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database of Systematic Reviews.

Pammi M & Suresh G. (2017). Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 6, CD007137-CD007137.

Payne V, Hall M, Prieto J & Johnson M. (2018). Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Archives of Disease in Childhood - Fetal and Neonatal Edition 103, F422.

Rao SC, Athalye-Jape GK, Deshpande GC, Simmer KN & Patole SK. (2016). Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis. Pediatrics 137, e20153684.

Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT, Blumberg HM, Pfaller M, Rinaldi M, Edwards JE, Wenzel RP, Jarvis W & Group Tneomss. (2001). Risk factors for Candida species colonization of neonatal intensive care unit patients. The Pediatric Infectious Disease Journal 20, 1119-1124.

Sandoval A, Cofré F, Delpiano L, Izquierdo G, Labraña Y & Reyes A. (2015). Reposicionando la cloxacilina como antibioticoterapia empírica inicial de la sepsis tardía neonatal. Revista chilena de infectología 32, 182-189.

Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM & Ascher DP. (1996). Volume of blood required to detect common neonatal pathogens. J Pediatr 129, 275-278.

Schulman J, Stricof R, Stevens TP, Horgan M, Gase K, Holzman IR, Koppel RI, Nafday S, Gibbs K, Angert R, Simmonds A, Furdon SA & Saiman L. (2011). Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists. Pediatrics 127, 436-444.

Sinsky C & Rajcevich E. Implementing team-based care to increase practice efficiency: engage the entire team in caring for patients. American Medical Association; 2015 Accedido en: https://www.stepsforward.org/modules/team-based-care el 02 de febrero 2019.

Smith A, Saiman L, Zhou J, Della-Latta P, Jia H & Graham PL, 3rd. (2010). Concordance of Gastrointestinal Tract Colonization and Subsequent Bloodstream Infections With Gram-negative Bacilli in Very Low Birth Weight Infants in the Neonatal Intensive Care Unit. The Pediatric infectious disease journal 29, 831-835.

Ting JY, Synnes A, Roberts A, Deshpandey A, Dow K, Yoon EW, Lee K-S, Dobson S, Lee SK, Shah PS & Investigators ftCNN. (2016). Association Between Antibiotic Use and Neonatal Mortality and Morbidities in Very Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing EnterocolitisAntibiotic Use and Adverse Outcomes in Very Low-Birth-Weight Infants Without Proven SepsisAntibiotic Use and Adverse Outcomes in Very Low-Birth-Weight Infants Without Proven Sepsis. JAMA Pediatrics 170, 1181-1187.

Toso A, Vaz Ferreira MC, Herrera TI, Villarroel L, Brusadin M, Escalante MJ, Masoli D, D’Apremont IL, Mariani G, Tapia JL and Neocosur Neonatal Network. (2018). Mortality in Very Low Birth Weight (VLBW) Infants in the South American NEOCOSUR Network: Timing and Causes. Pediatric Academic Societies Meeting 2018.

Urzúa S, Ferrés M, García P, Sánchez A & Luco M. (2017). Estrategias para reducir infecciones, uso de antimicrobianos y sus efectos en una unidad de neonatología. Revista chilena de infectología 34, 99-107.

Van den Akker CHP, van Goudoever JB, Szajewska H, Embleton ND, Hojsak I, Reid D, Shamir R, for the ESPGHAN Working Group for Probiotics P & Nutrition Co. (2018). Probiotics for Preterm Infants: A Strain-Specific Systematic Review and Network Meta-analysis. Journal of Pediatric Gastroenterology and Nutrition 67, 103-122.

Van Houten MA, Uiterwaal CSPM, Heesen GJM, Arends JP & Kimpen JLL. (2001). Does the empiric use of vancomycin in pediatrics increase the risk for Gram-negative bacteremia? The Pediatric Infectious Disease Journal 20, 171-177.

Villena R, Vidal P, Carrillo F & Salinas M. (2017). Vacunación con pertussis en el embarazo: una estrategia segura y efectiva para proteger al lactante menor. Revista chilena de pediatría 88, 318-323.

Descargas

Publicado

2019-09-27

Número

Vol. 44 Núm. 3 (2019)

Sección

Revisión narrativa

Licencia

Derechos de autor 2019 ARS MEDICA Revista de Ciencias Médicas

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.

A partir del 1 de octubre 2023, los autores/as conservan sus derechos de autor y garantizan a la revista el derecho de primera publicación de su obra, la que estará simultáneamente sujeta a la Licencia CC BY-SA 4.0 (Ver declaración de Acceso Abierto).