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Critical Care Research and Practice
Volume 2014, Article ID 480463, 12 pages
http://dx.doi.org/10.1155/2014/480463
Review Article

Gram-Negative Infections in Adult Intensive Care Units of Latin America and the Caribbean

1Pulmonary Division, Department of Medicine, José de San Martin Hospital, University of Buenos Aires, Arenales 2557, Piso 1, Dep. A, 1425 Buenos Aires, Argentina
2Hospital Civil de Guadalajara “Fray Antonio Alcalde” and Institute of Infectious and Experimental Pathology, University Center of Health Sciences, University of Guadalajara, Guadalajara, JAL, Mexico
3Clinica Reñaca, Viña Del Mar, Chile
4Private Hospital Medical Center of Caracas and Vargas Hospital of Caracas, Caracas, Venezuela

Received 13 May 2014; Revised 2 November 2014; Accepted 4 November 2014; Published 27 November 2014

Academic Editor: Ali A. El-Solh

Copyright © 2014 Carlos M. Luna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.