1589. Statewide spatial distribution of catheter-related bloodstream infection caused by multidrug-resistant organisms in intensive care units in São Paulo State, Brazil
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Multidrug-resistant organism incidence is increasing worldwide. The objective  of this work is to describe spatial distribution of the incidence of  catheter-related bloodstream infection (CLABSI)  caused by  MDRO in intensive care units (ICU) in 2011 in Sao Paulo, Brazil.


Study area

The State of São Paulo is located in southeast of Brazil with 41.262.199 inhabitants in 2010, yearly  per capita income US$ 5,400.00.

Epidemiological data

This state implemented a nosocomial infection surveillance system in 2004 and currently 357 ICUs send data to the system, including incidence of CLABSI per 1000 patients-day and susceptibility data concerning MDRO.  This study includes 321 ICUs with five or more beds in 2011.

Spatial data

Participant hospitals addresses were retrieved from infection control branch of health state department  and were geocoded using  Google EarthTM  version A database was created using  ArcGIS 10.0 (ESRI Corp., Berkeley California). Incidence rates were divided into quartiles and presented graphically in maps. Spatial dependency was tested by Moran index from a neighbourhood matrix obtained using  GEODATMsoftware. Matrix was generated using an eight nearest neighbours parameter and probability was calculated on a 999 permutation basis.


Maps were created for each MDRO and their incidences represented. The results of Moran index and the significance of its probability are presented in Table1.

Table1.Spatial dependency analysis of incidence of catheter-related bloodstream infections caused by multi-resistant organisms per 1000 patients-day in the State of Sao Paulo, Brazil in 2011


Moran index

p value

Acinetobacter spp. (CR)



Pseudomonas aeruginosa (CR)



Escherichia coli (CEF-R)



Klebsiella pneumoniae (CR)






Enterococcus sp (VRE)



CR: carbapenem-resistant; CEF-R: cephalosporin-resistant; MRSA: methicillin-resistant S. aureus; VRE: vancomycin-resistant entorococci


Carbapenem-resistant Pseudmononas aeruginosa was the only pathogen that showed a significant spatial dependency. Reasons for this dependency should be explored in further studies. This model may be a promising tool the evaluate associations between resistance, antimicrobial use and demographic data.

Ícaro Boszczowski, MD, MSc, Infection Control, Instituto Central - Hospital Das Clínicas, Sao Paulo, Brazil, Francisco Chiaravalloti Neto, PhD, Epidemiology, Public Health School University of Sao Paulo, Sao Paulo, Brazil, Geraldine Madalosso, MD MSc, Health State Department Sao Paulo, Sao Paulo, Brazil, Denise Assis, Centro de Vigilância Epidemiológica, State Health Department, São Paulo , Brazil, Thais Basso, engineer, Lemc, Sao Paulo, Brazil and Anna Sara Levin, MD, PhD, University of São Paulo, São Paulo, Brazil


Boszczowski, None

F. Chiaravalloti Neto, None

G. Madalosso, None

D. Assis, None

T. Basso, None

A. S. Levin, None

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