Asunto(s)
Unidades de Cuidados Intensivos , Neumonía Asociada al Ventilador/epidemiología , Calidad de la Atención de Salud , Respiración Artificial/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Centers for Disease Control and Prevention, U.S. , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Healthcare-associated infections (HCAIs) challenge public health in developing countries such as Brazil, which harbour social inequalities and variations in the complexity of healthcare and regional development. AIM: To describe the prevalence of HCAIs in hospitals in a sample of hospitals in Brazil. METHODS: A prevalence survey conducted in 2011-13 enrolled 152 hospitals from the five macro-regions in Brazil. Hospitals were classified as large (≥200 beds), medium (50-199 beds) or small sized (<50 beds). Settings were randomly selected from a governmental database, except for 11 reference university hospitals. All patients with >48 h of admission to the study hospitals at the time of the survey were included. Trained epidemiologist nurses visited each hospital and collected data on HCAIs, subjects' demographics, and invasive procedures. Univariate and multivariate techniques were used for data analysis. FINDINGS: The overall HCAI prevalence was 10.8%. Most frequent infection sites were pneumonia (3.6%) and bloodstream infections (2.8%). Surgical site infections were found in 1.5% of the whole sample, but in 9.8% of subjects who underwent surgical procedures. The overall prevalence was greater for reference (12.6%) and large hospitals (13.5%), whereas medium- and small-sized hospitals presented rates of 7.7% and 5.5%, respectively. Only minor differences were noticed among hospitals from different macro-regions. Patients in intensive care units, using invasive devices or at extremes of age were at greater risk for HCAIs. CONCLUSION: Prevalence rates were high in all geographic regions and hospital sizes. HCAIs must be a priority in the public health agenda of developing countries.
Asunto(s)
Infección Hospitalaria/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Femenino , Hospitales , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
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
PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.
Asunto(s)
Infecciones Relacionadas con Catéteres/epidemiología , Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Infecciones Urinarias/epidemiología , Américas/epidemiología , Asia/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Países en Desarrollo/estadística & datos numéricos , Europa (Continente)/epidemiología , Femenino , Higiene de las Manos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Catéteres Urinarios/estadística & datos numéricos , Infecciones Urinarias/prevención & controlRESUMEN
Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69,248 admissions followed for 283,069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2·03 days (95% CI 1·52-2·54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.
Asunto(s)
Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Neumonía Asociada al Ventilador/mortalidad , Estudios de Cohortes , Países en Desarrollo/estadística & datos numéricos , Humanos , Índice de Severidad de la EnfermedadRESUMEN
Imipenem-resistant Pseudomonas aeruginosa is a leading cause of hospital-acquired pneumonia. Aiming to determine the risk factors associated for hospital-acquired pneumonia due to imipenem-resistant Pseudomonas aeruginosa, we undertook a retrospective case-case-control study. Patients admitted to a 14-bed medical-surgical intensive care unit from a university-affiliated hospital with hospital-acquired pneumonia caused by imipenem-resistant Pseudomonas aeruginosa strains and by imipenem-susceptible Pseudomonas aeruginosa strains were matched to control patients by time under risk and comorbidities. A total of 58 resistant cases, 47 susceptible cases and 237 controls were evaluated. The risk factors independently associated to hospital-acquired pneumonia caused by imipenem-resistant Pseudomonas aeruginosa were: duration of hospitalisation, Acute Physiological and Chronic Health Evaluation II score, male gender receipt of haemodialysis, receipt of piperacillin-tazobactam and receipt of third-generation cephalosporins.
Asunto(s)
Antibacterianos/farmacología , Infección Hospitalaria/etiología , Imipenem/farmacología , Unidades de Cuidados Intensivos , Neumonía Bacteriana/etiología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Estudios de Casos y Controles , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/microbiología , Factores de RiesgoRESUMEN
A simultaneous pancreas-kidney transplantation (SPKT) is the best treatment option for type I diabetic patients with advanced chronic renal failure. Infectious complications affect 7-50% of the patients receiving this procedure. We conducted a nested case-control study to assess the risk factors for surgical site infection (SSI) in patients receiving SPKT at our centre between 2000 and 2006. Of the 119 evaluated transplant recipients, 55 (46.2%) developed SSIs and the 30 day mortality was 11.8%. Gram-negative organisms were the predominant organisms isolated from SSIs. After multivariate logistic regression, the variables independently associated with SSI were: acute tubular necrosis, post-transplant fistula and graft rejection. This study demonstrated a high incidence of SSI in this patient cohort and variables related to the surgical procedure were closely associated with the development of SSI.
Asunto(s)
Trasplante de Riñón/efectos adversos , Trasplante de Páncreas/efectos adversos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Brasil , Estudios de Casos y Controles , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Hospitales , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infección de la Herida Quirúrgica/mortalidad , Adulto JovenAsunto(s)
Bacteriemia/epidemiología , Infección Hospitalaria/epidemiología , Fungemia/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Brasil/epidemiología , Candida/clasificación , Candida/aislamiento & purificación , Candida albicans/aislamiento & purificación , Candidiasis/epidemiología , Candidiasis/microbiología , Candidiasis/mortalidad , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Fungemia/microbiología , Fungemia/mortalidad , Bacterias Gramnegativas/clasificación , Bacterias Gramnegativas/aislamiento & purificación , Cocos Grampositivos/clasificación , Cocos Grampositivos/aislamiento & purificación , IncidenciaRESUMEN
Candidemia is associated with high morbidity and mortality resulting in significant increases in the length of patients' hospitalization and in healthcare costs. Critically ill patients are at particular risk for candidemia because of their debilitated condition and frequent need for invasive procedures. The aim of this study was to characterize the incidence and epidemiology of candidemia over a seven-year period in intensive care units (ICUs) and the use of fluconazole and caspofungin in a large university-affiliated hospital. All cases of candidemia were identified by surveillance, using the Centers for Diseases Control and Prevention criteria. Demographic variables, use of antifungal (fluconazole and caspofungin) and patient outcomes were evaluated. The chi2 test for linear trend was employed to evaluate the distribution of Candida spp. and the use of fluconazole and caspofungin by defined daily dose (DDD) per 1,000 patients-days during the study period. One hundred and eight episodes of candidemia were identified. The overall incidence of candidemia (P=0.20) and incidence of non-Candida albicans Candida infections (P=0.32) remained stable over the study period and ranged from 0.3-0.9 episodes per 1,000 catheter-days and 0.39-0.83 episodes per 1,000 patients-days. However, the use of fluconazole and caspofungin increased significantly (P<0.001). While there were no reports of the use of fluconazole for prophylaxis in 1999, its use for this purpose increased from 3% in 2000 to 7.0% (P=0.07) in 2006. C. albicans was the most frequent specie isolated and burns and cancer were the most frequent underlying conditions. The overall mortality was 76%. There was no difference between C. albicans and non-C. albicans Candida infections when the crude and 14-day mortality rates were compared. Our data demonstrated that C. albicans is still the most frequent species causing candidemia in our intensive care units. Our rates of candidemia are lower than those reported from the region and similar to American and European hospitals. Although the incidence of blood stream infections (BSI) and candidemia remained stable, the use of fluconazole and caspofungin increased significantly over the years included in this study but had no impact on the incidence of infections caused by non-C. albicans Candida species.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Candidiasis/epidemiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Equinocandinas/uso terapéutico , Fluconazol/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Candidiasis/microbiología , Caspofungina , Niño , Infección Hospitalaria/microbiología , Femenino , Hospitales Universitarios , Humanos , Incidencia , Unidades de Cuidados Intensivos , Lipopéptidos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The health care-related infections are well-known in a critical care setting, but reports of those infections in solid organ transplanted patients are scarce. We developed a study of retrospective cohort in a tertiary teaching hospital for 14 months. Eighty-one patients underwent solid organ transplants. The global incidence of health care-related infection was 42.0 percent. Fifteen percent of the cases were occurrences of surgical site infections, 14.0 percent pneumonias, 9.0 percent primary blood stream infections, 4.0 percent urinary tract infections and 2.0 percent skin infection. The most prevalent etiologic agents were K. pneumoniae (8.6 percent), P. aeruginosa (7.4 percent); A. baumannii (5.0 percent) and S. aureus (2.5 percent). Mortality was 18.0 percent, none of then related to health care infections. The high rate of those infections, mainly surgical site infections, suggests a demand for stricter measures to prevent and control health care-related infections.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Infección Hospitalaria/epidemiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Trasplante de Órganos , Brasil/epidemiología , Infección Hospitalaria/microbiología , Métodos Epidemiológicos , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Hospitales de EnseñanzaRESUMEN
The health care-related infections are well-known in a critical care setting, but reports of those infections in solid organ transplanted patients are scarce. We developed a study of retrospective cohort in a tertiary teaching hospital for 14 months. Eighty-one patients underwent solid organ transplants. The global incidence of health care-related infection was 42.0%. Fifteen percent of the cases were occurrences of surgical site infections, 14.0% pneumonias, 9.0% primary blood stream infections, 4.0% urinary tract infections and 2.0% skin infection. The most prevalent etiologic agents were K. pneumoniae (8.6%), P. aeruginosa (7.4%); A. baumannii (5.0%) and S. aureus (2.5%). Mortality was 18.0%, none of then related to health care infections. The high rate of those infections, mainly surgical site infections, suggests a demand for stricter measures to prevent and control health care-related infections.
Asunto(s)
Infección Hospitalaria/epidemiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Trasplante de Órganos , Adulto , Brasil/epidemiología , Infección Hospitalaria/microbiología , Métodos Epidemiológicos , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Hospitales de Enseñanza , Humanos , MasculinoRESUMEN
SETTING: A major university in São Paulo, Brazil, where vaccination against tuberculosis (TB) with bacille Calmette-Guerin (BCG) was routinely offered to first-year medical and nursing students. OBJECTIVES: To estimate the probability of negative tuberculin skin test (TST) results over a 4-year period following BCG revaccination, and to evaluate the effect of factors associated with reversion. DESIGN: Students were enrolled in 1997, initially given a two-step TST, and were retested annually or biannually for the duration of the study. Data on TB exposures and potential risk factors for TST negativity and reversion were collected through annual surveys. A linear mixture survival model was used to estimate the probability of negative TST results over time. RESULTS: Of 159 students, an estimated 20% had a negative TST result despite revaccination, and a further 31% reverted to negative over 4 years of follow-up. No cofactors significantly affected the probability of reversion. CONCLUSION: Overall, in the absence of reported exposure to Mycobacterium tuberculosis, 51% of students revaccinated upon entering nursing or medical school would have a negative TST result by the time they begin their internships. In this recently vaccinated population, reversion was common, suggesting that annual TST screening may remain a useful tool.
Asunto(s)
Vacuna BCG , Estudiantes de Medicina , Estudiantes de Enfermería , Prueba de Tuberculina , Tuberculosis/diagnóstico , Adolescente , Adulto , Brasil , Femenino , Humanos , Masculino , Exposición Profesional , Estudiantes de Medicina/estadística & datos numéricos , Estudiantes de Enfermería/estadística & datos numéricosRESUMEN
In order to analyse the impact of oxacillin resistance on the mortality of Staphylococcus aureus bacteremia, and to assess the antimicrobial susceptibility of community-acquired strains in two large university hospitals (the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo), we carried out a four-month-long prospective cohort study, which included 163 consecutive cases of S. aureus bacteremia. Of these, 140 (85.9%) were hospital-acquired, 9 (5.5%) were community-acquired and 14 (8.6%) were of indeterminate origin. No cases of community-acquired infection by oxacillin-resistant S. aureus was identified. Among hospital-acquired infections, oxacillin-resistant S. aureus was responsible for 64.3% of cases. Mortality up to 15 days after diagnosis of bacteremia was 27% (18/67) for infections caused by susceptible strains and 33% (32/96) for infections caused by oxacillin-resistant strains (p=0.10). The following independent risk factors for the acquisition of oxacillin-resistant S. aureus were identified in multiple logistical regression analysis: age over 60 years, use of corticoids; presence of a central vascular catheter, and previous use of antibiotics.
Asunto(s)
Bacteriemia/mortalidad , Oxacilina/uso terapéutico , Resistencia a las Penicilinas , Infecciones Estafilocócicas/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Brasil/epidemiología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Factores de TiempoRESUMEN
In order to analyse the impact of oxacillin resistance on the mortality of Staphylococcus aureus bacteremia, and to assess the antimicrobial susceptibility of community-acquired strains in two large university hospitals (the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo), we carried out a four-month-long prospective cohort study, which included 163 consecutive cases of S. aureus bacteremia. Of these, 140 (85.9 percent) were hospital-acquired, 9 (5.5 percent) were community-acquired and 14 (8.6 percent) were of indeterminate origin. No cases of community-acquired infection by oxacillin-resistant S. aureus was identified. Among hospital-acquired infections, oxacillin-resistant S. aureus was responsible for 64.3 percent of cases. Mortality up to 15 days after diagnosis of bacteremia was 27 percent (18/67) for infections caused by susceptible strains and 33 percent (32/96) for infections caused by oxacillin-resistant strains (p=0.10). The following independent risk factors for the acquisition of oxacillin-resistant S. aureus were identified in multiple logistical regression analysis: age over 60 years, use of corticoids; presence of a central vascular catheter, and previous use of antibiotics.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Bacteriemia/mortalidad , Oxacilina/uso terapéutico , Resistencia a las Penicilinas , Infecciones Estafilocócicas/mortalidad , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Brasil/epidemiología , Estudios de Cohortes , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Staphylococcus aureus , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Factores de TiempoRESUMEN
SETTING: Four general Brazilian hospitals. OBJECTIVE: To assess the occupational risk of Mycobacterium tuberculosis (TB) in participating hospitals. DESIGN: In phase one of this longitudinal study, a cross-sectional survey documented baseline tuberculin skin test (TST) positivity rates. In phase two, TST conversion rates were evaluated in participants with an initial negative two-step TST. TST conversion data were analyzed to determine risk factors for TB infection using an increase of > or = 10 mm compared to baseline TST. RESULTS: The initial TST positivity rate was 63.1%; the follow-up TST conversion rate was 10.7 per 1000 person-months (p-m). Hospital of employment, recent bacille Calmette-Guerin (BCG) vaccination, nosocomial TB exposure, and employment as a nurse were independent risk factors for TST conversion. Hospitals without TB infection control measures had higher conversion rates than those with control measures (16.0 vs. 7.8/ 1000 p-m, P < 0.001). CONCLUSIONS: This study indicates an important occupational risk of infection in health care settings with a high TB incidence. Longitudinal TST studies are a valuable tool to assess the occupational risk of TB, even in BCG-vaccinated populations, and should be used to direct limited resources for infection control.
Asunto(s)
Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Personal de Hospital , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vacuna BCG , Brasil , Femenino , Hospitales Generales , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Factores de Riesgo , Estudios Seroepidemiológicos , Prueba de Tuberculina , Tuberculosis/etiología , Tuberculosis/prevención & controlRESUMEN
Evaluation of HIV-induced IL-2 production by peripheral blood mononuclear cells (PBMC) and HIV-specific T helper and cytotoxic T lymphocyte (CTL) responses in health care workers (HCW) occupationally exposed to HIV reveals a high rate of response to HIV among non-seroconverters. IL-10 is also known to interfere with HIV infection in vitro. To evaluate the induction of IL-10 by HIV antigens in HCW occupationally exposed to HIV, 18 HCW with percutaneous injury were enrolled in this study, 9 of them exposed to HIV-contaminated blood, and 9 exposed to HIV-negative blood. PBMC were incubated on plates coated with HIV-1 antigens, and IL-10 was measured in supernatants by ELISA. Five of nine HCW exposed to HIV-contaminated blood presented HIV-induced IL-10. Two of nine HCW exposed to HIV-negative source patients also had detectable levels of HIV-induced IL-10, one of them in the sample obtained on the day of accidental exposure. There was a relationship between the type of device involved in injury and IL-10 production. Individuals exposed to hollow needles or scalpels presented HIV-induced IL-10, whereas those exposed to solid needles and to digital puncture did not, suggesting a relationship between infectious load and IL-10. Although occupational exposure to HIV leads to a low rate of seroconversion, these individuals can develop an antigen-specific immune response characterized in our study by induction of IL-10 in PBMC in vitro.
Asunto(s)
Antígenos VIH/inmunología , VIH-1/inmunología , Personal de Salud , Interleucina-10/biosíntesis , Leucocitos Mononucleares/metabolismo , Exposición Profesional , Accidentes de Trabajo , Infecciones por VIH/inmunología , Infecciones por VIH/transmisión , Seronegatividad para VIH/inmunología , Seropositividad para VIH/inmunología , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Interleucina-10/análisis , Leucocitos Mononucleares/química , Lesiones por Pinchazo de Aguja/inmunologíaRESUMEN
Evaluation of HIV-induced IL-2 production by peripheral blood mononuclear cells (PBMC) and HIV-specific T helper and cytotoxic T lymphocyte (CTL) responses in health care workers (HCW) occupationally exposed to HIV reveals a high rate of response to HIV among non-seroconverters. IL-10 is also known to interfere with HIV infection in vitro. To evaluate the induction of IL-10 by HIV antigens in HCW occupationally exposed to HIV, 18 HCW with percutaneous injury were enrolled in this study, 9 of them exposed to HIV-contaminated blood, and 9 exposed to HIV-negative blood. PBMC were incubated on plates coated with HIV-1 antigens, and IL-10 was measured in supernatants by ELISA. Five of nine HCW exposed to HIV-contaminated blood presented HIV-induced IL-10. Two of nine HCW exposed to HIV-negative source patients also had detectable levels of HIV-induced IL-10, one of them in the sample obtained on the day of accidental exposure. There was a relationship between the type of device involved in injury and IL-10 production. Individuals exposed to hollow needles or scalpels presented HIV-induced IL-10, whereas those exposed to solid needles and to digital puncture did not, suggesting a relationship between infectious load and IL-10. Although occupational exposure to HIV leads to a low rate of seroconversion, these individuals can develop an antigen-specific immune response characterized in our study by induction of IL-10 in PBMC in vitro
Asunto(s)
Humanos , Accidentes de Trabajo , Personal de Salud , VIH-1 , Interleucina-10 , Leucocitos Mononucleares , Exposición Profesional , Infecciones por VIH , Seronegatividad para VIH , Seropositividad para VIH , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Interleucina-10 , Leucocitos Mononucleares , Lesiones por Pinchazo de AgujaRESUMEN
The cellular immune response probably plays a pivotal role in determining the clinical outcome after exposure to Mycobacterium tuberculosis. We used multi-parameter flow-cytometry to evaluate the distribution of T-lymphocyte subsets during infection and disease caused by M. tuberculosis. Samples were obtained from 71 volunteers to identify the T CD4+ and CD8+ lymphocyte numbers, and the activation plus memory/naïve phenotypes, as defined by CD38, HLA-DR, CD45RA and CD27 markers. Subjects were divided into 18 healthy volunteers without detectable reaction to purified protein derivative (PPD-), 18 health care workers with a recent conversion to PPD, 20 patients with active pulmonary tuberculosis (TBC) and 15 patients with treated TBC at 6 months of therapy. By multiple-comparison analyses, the T CD4+ lymphocyte number of the TBC group was lower than the PPD- group (P < 0.05). This difference was apparently lost after treatment. The higher and the lower number of naïve T CD4+ cells was observed in the PPD- and TBC group, respectively. CD8+ T lymphocytes were also statistically different among the four groups (P = 0.0002), lower in the TBC group (P < 0.05). CD8+ T lymphocyte activation was evaluated by the CD38 and HLA-DR surface expression. The percentage distribution of these markers was statistically different between the four groups (P = 0.0055). TBC patients had a higher percentage of CD38+ cells and mean fluorescence index, suggesting an overall increase of cell activation. These results suggest that peripheral T lymphocytes reflect cellular activation during TBC, along with possible redistribution of naïve, memory/effector and late differentiated memory/effector phenotypes in the peripheral blood after infection and disease caused by M. tuberculosis.
Asunto(s)
Antígenos CD , Mycobacterium tuberculosis , Subgrupos de Linfocitos T/inmunología , Tuberculosis Pulmonar/inmunología , ADP-Ribosil Ciclasa , ADP-Ribosil Ciclasa 1 , Adolescente , Adulto , Antígenos de Diferenciación/análisis , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Femenino , Citometría de Flujo , Antígenos HLA-DR/análisis , Humanos , Memoria Inmunológica , Inmunofenotipificación , Antígenos Comunes de Leucocito/análisis , Activación de Linfocitos , Recuento de Linfocitos , Masculino , Glicoproteínas de Membrana , Persona de Mediana Edad , NAD+ Nucleosidasa/análisis , Subgrupos de Linfocitos T/clasificación , Miembro 7 de la Superfamilia de Receptores de Factores de Necrosis Tumoral/análisisRESUMEN
From June 1998 through July 2000, 28 patients with tetanus admitted to the Intensive Care Unit for Tetanus and Infectious Diseases at the Hospital das Clínicas of University of Medicine at São Paulo, Brazil, were evaluated to establish what the incidence of nosocomial pneumonia was and what their risk factors were. The degree of severity of tetanus was assessed in all patients by means of APACHE II scores. The mortality rate was 3.6%. There were 63 hospital infections in 20 patients; among these, there were 10 cases of nosocomial pneumonia in 8 patients. Nosocomial pneumonia was associated in univariate analysis with the degree of severity of tetanus, dysautonomy, use of neuromuscular blockers, use of higher doses of diazepam, and lower arterial oxygen and oxygen fractions. In the multiple logistical regression, significance was found for dysautonomy (relative risk, 31.67; 95% confidence interval, 2.68-373.74; P=.006). Dysautonomy was an independent risk factor for pneumonia in patients with tetanus.