RESUMEN
BACKGROUND: The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. METHODS: This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. RESULTS: The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. CONCLUSION: Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.
Asunto(s)
Bacteriemia/epidemiología , Candidemia/epidemiología , Infección Hospitalaria/epidemiología , Receptores de Trasplantes/estadística & datos numéricos , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Brasil/epidemiología , Candidemia/microbiología , Niño , Preescolar , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Femenino , Fungemia/epidemiología , Fungemia/microbiología , Humanos , Lactante , Recién Nacido , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Adulto JovenRESUMEN
Compliance with hand hygiene is a good quality indicator for hospital patient safety programmes. Hand hygiene is a major infection control prevention intervention, but in many medical centres compliance rates are only c. 50%. Given the enormous number of hand hygiene opportunities in hospitals, direct observation to monitor compliance is very inefficient. However, technologies are emerging to obviate the need for direct observation. These new technologies for monitoring hand hygiene compliance are discussed in this article.
Asunto(s)
Desinfección de las Manos , Higiene de las Manos , Personal de Salud , Control de Infecciones , Infección Hospitalaria/prevención & control , Adhesión a Directriz , Hospitales , Humanos , Dispositivo de Identificación por Radiofrecuencia , Tecnología de Sensores Remotos , Tecnología InalámbricaRESUMEN
Antimicrobial- and antiseptic-impregnated catheters are strategies recommended to prevent central venous catheter (CVC) colonisation. Few data regarding chlorhexidine/silver sulfadiazine-impregnated catheters in intensive care unit (ICU) patients have been reported. We performed a prospective, randomised study comparing the colonisation rates of chlorhexidine/silver sulfadiazine-impregnated CVCs (group 1) against standard CVCs (group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the roll-plate method. In all, 109 patients were enrolled with successful catheter insertion, 51 of them in group 1 and 58 in group 2. There were no statistically significant differences between the two groups with regards to age, Sequential Organ Failure Assessment (SOFA) score, ICU admission diagnosis, infection risk, catheter insertion sites or catheter length of stay. The colonisation rates were 29.4% (15 catheters) for group 1 and 34.5% (20 catheters) for group 2 (P=0.50). Double-lumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients.
Asunto(s)
Antibacterianos/farmacología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo , Clorhexidina/farmacología , Equipos y Suministros/microbiología , Sulfadiazina de Plata/farmacología , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Femenino , Hongos/aislamiento & purificación , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Methicillin resistance in Staphylococcus aureus has rapidly increased over the last two decades. This increase is paralleled by the emergence of unique multi-resistant MRSA clones. In Brazil, Argentina, Uruguay, Portugal and Czech Republic a specific MRSA clone is widely spread, the so-called Brazilian epidemic clone. Another epidemic clone, the Iberian clone, is disseminated in Spain, Portugal, Belgium, Scotland, Italy, Germany and New York. Thus, a large number of hospital-acquired infections have been caused by specific MRSA clones. Using different molecular techniques for MRSA typing, we verified that two unique epidemic clones are spread over large geographic area in the US. In addition, we showed that a previously described MRSA clone type, the New York clone (I::A:A), is widely spread beyond the New York frontiers.