Diarréia nosocomial e outras infecções adquiridas em hospital universitário
Authors: Mesquita Ana Maria Ribeiro Cardoso , Rodrigues Jorge Luiz Nobre , Mesquita Vicente De Paulo , Lima Noélia Leal , Lima Aldo Ângelo Moreira 
Published: April 2018

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MÉTODOS – Estudo prospectivo caso-controle de 18 de setembro de 1991 a 30 de junho de 1993. Durante visitas semanais, investigou-se a diarreia nosocomial. Foram realizadas coproculturas, testes imunológicos para toxina A de C. difficile (ELISA TOX-A), para Rotavirus (ELISA Rotaclone) e testes sorológicos para Shigella spp. Os casos desenvolveram diarreia nosocomial, e os controles não desenvolveram. A colite pseudomembranosa (CPM) foi investigada nos óbitos. Em adição, comparamos dados deste estudo com a configuração de 2007. RESULTADOS – Dos 388 pacientes internados, 66 (63 adultos) foram selecionados para o estudo, 19 adquiriram diarreia nosocomial e 47 foram controles. A incidência da diarreia nosocomial foi de 4,9% e de infecção sanguínea 6,2%. Os mais importantes patógenos isolados foram Rotavírus [(26,66%)/(7,89%)], C. difficile enterotoxigênico [(18,75%)/(5,26%)] e Shigella flexneri [(5,55%)/(0%)] de casos e controles, respectivamente. Penicilinas e cefalosporinas foram associadas com diarreia nosocomial. CPM foi identificada durante necropsia em um paciente assintomático. A taxa global de infecção hospitalar na hematologia no estudo caso–controle foi de 33,5%. Em 2007, foi de 29%; sete pacientes tiveram diarreia e cinco deles com quadro clínico sugestivo de colite. CONCLUSÕES – Diarreia é uma importante complicação em pacientes da Hematologia; sua frequência é alta e está associada ao uso de antibióticos beta-lactâmicos. Gastrenterite foi a segunda mais frequente infecção nosocomial, perdendo para infecção sanguínea. Rotavírus foi o mais frequente patógeno entérico isolado, seguido de C. difficile enterotoxigênico e Shigella flexneri. Achado de CPM sugere condição de transportador assintomático de C. difficile. Faz-se necessário contínuo monitoramento da diarreia nosocomial.</p>