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BACKGROUND: Peru reports higher levels than other countries in Latin America of resistance to antimicrobials among Gram-positive and Gram-negative bacteria, however data on antibiotic use in Peru are scarce. This study aims to estimate the prevalence and quality of antibiotic prescription in hospitalized patients and to determine the antibiotic susceptibility rates of bacteria causing key bacterial infections. METHODS: We carried out a point prevalence survey of antibiotic prescription at ten public hospitals in nine regions of Peru. Data was collected from patients hospitalized during a 3-week period, with details about antibiotic use, patient information, and antimicrobial susceptibility. RESULTS: 1620 patient charts were reviewed; in 924 cases antibiotics were prescribed (57.0 %, range 45.9-78.9 %). Most of the antibiotics (74.2 %) were prescribed as empirical treatment, only 4.4 % as targeted treatment. For 9.5 % of cases the reason for antibiotic use was unknown. Cephalosporins were the most prescribed (30.0 %), followed by carbapenems (11.3 %). Ninety-four blood cultures were positive for bacterial growth, 48.8 % of the Staphylococcus aureus were methicillin-resistant, among Escherichia coli and Klebsiella pneumoniae, 51.7 % and 72.7 % were resistant to third-generation cephalosporins (3GC), 3.4 % and 18.2 % were resistant to carbapenems, respectively. Among bacteria isolated from urine cultures (n = 639), 43.9 % of E. coli and 49.2 % of K. pneumoniae were resistant to 3GC, and 0.9 % of E. coli and 3.2 % of K. pneumoniae were resistant to meropenem. CONCLUSIONS: The overall proportion of hospitalized patients receiving antibiotics in hospitals from different regions in Peru was high, with only a small proportion receiving targeted treatment. Cephalosporins and carbapenems were the most frequently prescribed antibiotics, reflecting high resistance rates against 3GC and carbapenems in Enterobacterales isolated from blood and urine.
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Antibacterianos , Antiinfecciosos , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Prevalencia , Perú/epidemiología , Escherichia coli , Bacterias Gramnegativas , Farmacorresistencia Bacteriana , Bacterias Grampositivas , Cefalosporinas , Carbapenémicos/farmacología , Bacterias , Antiinfecciosos/farmacología , Hospitales , Pruebas de Sensibilidad MicrobianaRESUMEN
Resumen: Introducción: Las infecciones nosocomiales constituyen uno de los principales problemas sanitarios a nivel mundial. Una de las más frecuentes es la infección del tracto urinario, cuya frecuencia reportada en Uruguay fue de 9,8% en unidades de Cuidados Intensivos al año 2013. El objetivo fue determinar la prevalencia de infecciones urinarias nosocomiales en salas de cuidados moderados de un hospital universitario, conocer los factores de riesgo asociados a las mismas y el perfil microbiológico de los microorganismos causales. Metodología: Estudio de corte transversal, en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, desde el 1 de agosto de 2017 hasta el 31 de julio de 2018. Se incluyeron pacientes que cumplieron criterios diagnósticos de infección urinaria nosocomial, con urocultivo compatible obtenido luego de 3 días del ingreso. Se completó la recolección de variables mediante entrevista con el paciente y revisión de historia clínica. Resultados: La prevalencia de infección urinaria nosocomial fue de 1,08% en el período de estudio. La mediana de edad fue 62,5 años y 52,3% eran de sexo masculino. La mediana de internación fue de 15 días, la mayoría en salas de Medicina Interna. El 93,2% presentó al menos un factor de riesgo, destacando la exposición a catéter urinario en el 68,3%. El 52,3% de los casos presentó infección urinaria asociada a catéter. El total de los aislamientos microbiológicos fue bacteriano, 84% de bacterias Gram negativas. Klebsiella pneumoniae fue el más prevalente (39,2%), seguido de Escherichia coli (34,2%). Las bacterias Gram positivas correspondieron en su totalidad a Enterococcus spp. Las bacterias Gram negativas mostraron tasas de resistencia mayores al 20% para múltiples antibióticos de varias categorías y 42,1% presentó betalactamasa de espectro extendido. Conclusiones: Las infecciones urinarias nosocomiales en cuidados moderados se presentaron en pacientes con internación prolongada y múltiples comorbilidades. Destaca la exposición a catéter urinario, con un elevado porcentaje de infecciones asociadas al mismo. Los microorganismos causales fueron altamente resistentes a múltiples antibióticos.
Abstract: Introduction: Nosocomial infections are one of the main health problems worldwide. One of the most frequent is urinary tract infection, whose frequency reported in Uruguay was 9.8% in Intensive Care Units in 2013. The objective was to determine the prevalence of nosocomial urinary tract infections in moderate care wards of a universitary hospital, know the risk factors associated with them and the microbiological profile of the causal microorganisms. Methodology: Cross-sectional study, in moderate care wards of a tertiary and universitary hospital in Montevideo, from August 1, 2017 to July 31, 2018. Patients who met diagnostic criteria for nosocomial urinary tract infection were included, with compatible urine culture obtained after 3 days of admission. Variables collection was made through an interview with the patient and a review of the clinical history. Results: The prevalence of nosocomial urinary tract infection was 1.08% during the study period. The median age was 62.5 years and 52.3% were male. The median hospital stay was 15 days, most of them in Internal Medicine wards. 93.2% presented at least one risk factor, highlighting exposure to urinary catheter in 68.3%. 52.3% of the cases presented catheter-associated urinary tract infection. The total of the microbiological isolates was bacterial, 84% of Gram negative bacteria. Klebsiella pneumoniae was the most prevalent (39.2%), followed by Escherichia coli (34.2%). The Gram-positive bacteria corresponded entirely to Enterococcus spp. Gram-negative bacteria showed resistance rates greater than 20% for multiple antibiotics from various categories and 42.1% had extended-spectrum beta-lactamase. Conclusions: Nosocomial urinary tract infections in moderate care occur in patients with prolonged hospitalization and multiple comorbidities. Exposure to urinary catheter stands out, with a high percentage of infections associated with it. The causative microorganisms were highly resistant to multiple antibiotics.
Resumo: Introdução: As infecções hospitalares são um dos principais problemas sanitários a nível mundial. Uma das mais frequentes é a infecção do trato urinário, cuja frequência relatada no Uruguai foi de 9,8% nas Unidades de Terapia Intensiva em 2013. O objetivo foi determinar a prevalência de infecções do trato urinário hospitalares em enfermarias de cuidados moderados de um hospital universitário, conhecer os fatores de risco associados e o perfil microbiológico dos microrganismos causadores. Metodologia: Estudo de corte transversal, em salas de cuidados moderados de um hospital terciário e universitário de Montevidéu, de 1º de agosto de 2017 a 31 de julho de 2018. Foram incluídos pacientes que preencheram os critérios diagnósticos para infecção do trato urinário hospitalar, com urocultura compatível obtida após 3 dias de admissão. A coleta de variáveis foi completada por meio de entrevista com o paciente e revisão da história clínica. Resultados: A prevalência de infecção urinária hospitalar foi de 1,08% no período estudado. A média de idade foi de 62,5 anos e 52,3% eram do sexo masculino. A média de permanência hospitalar foi de 15 dias, a maioria em enfermarias de Clínica Médica. O 93,2% apresentaram pelo menos um fator de risco, destacando-se a exposição ao cateter urinário em 68,3%. O 52,3% dos casos apresentaram infecção do trato urinário associada ao cateter. O total de isolados microbiológicos foi bacteriano, 84% de bactérias Gram-negativas. Klebsiella pneumoniae foi a mais prevalente (39,2%), seguida de Escherichia coli (34,2%). As bactérias Gram-positivas corresponderam inteiramente a Enterococcus spp . As bactérias Gram-negativas apresentaram taxas de resistência superiores a 20% para vários antibióticos de várias categorias e 42,1% apresentaram betalactamasa de espectro estendido. Conclusões: Infecções do trato urinário hospitalares em cuidados moderados ocorreram em pacientes com internação prolongada e múltiplas comorbidades. Destaca-se a exposição ao cateter urinário, com alto percentual de infecções associadas a ele. Os microrganismos causadores foram altamente resistentes a múltiplos antibióticos.
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A Dor Lombar (DL) constitui um problema de saúde pública, já que se espera que quase todo indivíduo experimente lombalgia pelo menos uma vez durante a vida. OBJETIVO: Este estudo é feito para determinar a prevalência de LBP e fatores associados em uma comunidade urbana da Nigéria. MÉTODOS E MATERIAIS: Esta pesquisa domiciliar transversal selecionou aleatoriamente 741 indivíduos usando uma técnica de amostragem de quatro estágios. Os dados foram obtidos por meio de questionário semiestruturado autoaplicável. A associação entre variáveis categóricas e lombalgia foi analisada por meio do teste Qui-quadrado e modelo de regressão logística múltipla (α = 0.05). RESULTADOS: A média de idade dos participantes foi 41,32 ± 15,24 anos. A prevalência pontual, anual e ao longo da vida de lombalgia foram 31,2%, 61,1% e 70,6%, respectivamente. Idade igual ou superior a 40 anos (p = 0,006), ser artesão (p = 0,005) ou comerciante (p = 0,007) em comparação a ser trabalhador de escritório (p = 0,071) e ficar sentado continuamente por mais de 3 4 horas (p< 0,001) são fatores significativamente associados à DL. Outros são a duração do transporte de / para o trabalho maior ou igual a 30 minutos (p <0,001), uso de computador (p <0,001), história de trauma (p =0,045), nunca compareceu a uma palestra de saúde sobre cuidados nas costas (p <0,001), tabagismo (p = 0,006) e prática ocasional (p = 0,002) ou nenhuma rotina de exercícios (p <0,001). CONCLUSÃO: DL é comum entre os indivíduos na área de estudo com uma prevalência pontual, anual e ao longo da vida de 31.2%, 61.1% e 70.6%, respectivamente. As intervenções na prevenção da DL devem ter como objetivo a correção de fatores associados modificáveis identificados, como postura inadequada, inatividade física e falta de informações sobre lombalgia.
Low Back Pain (LBP) constitutes a public health problem as almost every individual is expected to experience LBP at least once during their lifetime. OBJECTIVE: This study is done to determine the prevalence of LBP and associated factors in an urban Nigerian community. METHODS AND MATERIALS: This cross-sectional household survey randomly selected 741 subjects using a 4-stage sampling technique. Data were obtained through a self-administered semi-structured questionnaire. Association between categorical variables and LBP was analyzed using the Chi-square test and multiple logistic regression model (α=0.05). RESULTS: Mean age of participants was 41.32 ± 15.24 years. The point, annual, and lifetime prevalence of LBP were 31.2%, 61.1%, and 70.6% respectively. Aged 40 years and above (p=0.006), being an artisan (p=0.005) or trader (p=0.007) compared to being an office worker (p=0.071), and continuously sitting more than 3 to 4 hours (p<0.001) are factors significantly associated with LBP. Others are transport duration to/from work more than or equal to 30 minutes (p<0.001), computer use (p<0.001), trauma history (p=0.045), never attending a health talk on back care (p<0.001), tobacco smoking history (p=0.006) and having an occasional (p=0.002) or no exercise routine (p<0.001). CONCLUSION: LBP is common among individuals in the study area with a point, annual, and lifetime prevalence of 31.2%, 61.1%, and 70.6% respectively. Interventions on LBP prevention should target correction of identified modifiable associated factors such as poor posture, physical inactivity and lack of information on LBP.
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Dolor de la Región Lumbar , Características de la Residencia , NigeriaRESUMEN
A dor osteoarticular relacionada ao trabalho (DORT) é um sintoma comum associado a perturbações musculoesqueléticas relacionadas com o trabalho. É agravada por más técnicas de elevação, ergonomia inadequada, movimentos repetitivos e postura incômoda durante o exercício das suas funções. Variáveis como a idade, o estado civil, a experiência profissional, o álcool, o tabagismo e os hábitos de exercício têm desempenhado um papel importante na prevalência das DORT entre as diferentes categorias de trabalhadores. OBJETIVOS: este estudo centrou-se na prevalência ao longo da vida, de 12 meses e pontos das WMSP em associação com as características sociodemográficas, de estilo de vida e de trabalho dos trabalhadores da indústria cervejeira no Estado de Osun, sudoeste, Nigéria. MÉTODO: um design de pesquisa descritiva foi utilizado, e um total de oitenta e nove (89) participantes foram recrutados com estrita adesão aos critérios de inclusão. Foi desenvolvido um questionário de 28 itens para obter informações específicas sobre a prevalência e o padrão de DORT, enquanto medições antropométricas (peso e altura) de cada participante foram medidas. Os dados coletados foram organizados e analisados usando estatísticas descritivas e teste de Qui quadrado. RESULTADOS: A prevalência de DORT ao longo da vida, 12 meses e pontos entre os participantes foi de 96,6%, 93,3% e 57,3%, respectivamente. As costas baixas eram a região corporal mais afetada. Existem associações significativas entre cada uma das idades, a prevalência de 12 meses e pontos das DORT e o estado civil dos participantes. Além disso, existe uma associação significativa entre a prevalência pontual de DORT e a idade dos participantes. CONCLUSÃO: concluiu-se que havia uma elevada prevalência de DORT entre os trabalhadores da cervejaria no Estado de Osun, sudoeste, Nigéria.
Work-related musculoskeletal pain (WMSP) is a common symptom associated with workrelated musculoskeletal disorders. It is aggravated by poor lifting techniques, inappropriate ergonomics, repetitive movements and awkward posture during the course of performing one's duties. Variables such as age, marital status, work experience, alcohol, smoking and exercise habits have been found to play major roles in WMSP prevalence among different categories of workers. OBJECTIVES: This study focused on the lifetime, 12-month and point prevalence of WMSP in association with the socio-demographics, lifestyle and work-related characteristics of brewery workers in Osun state, Southwest, Nigeria. METHOD: A descriptive research design was utilized, and a total of eightynine (89) participants were recruited with strict adherence to the inclusion criteria. A 28-item questionnaire was developed to obtain specific information on the prevalence and pattern of WMSP, while anthropometric measurements (weight and height) of each participant were measured. Collected data were organized and analyzed using descriptive statistics and Chi square test. RESULTS: The lifetime, 12-month and point prevalence of WMSP among the participants were 96.6%, 93.3%, and 57.3% respectively. The low back was the mostly affected body region. Significant associations exist between each of the lifetime, 12-month and point prevalence of WMSP and participants' marital status. Furthermore, a significant association exists between the point prevalence of WMSP and participants' age. CONCLUSION: It was concluded that there was a high prevalence of WMSP among brewery workers in Osun state, Southwest, Nigeria.
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Dolor Musculoesquelético , Grupos Profesionales , NigeriaRESUMEN
BACKGROUND: The inappropriate use of antimicrobials and increased rates of antimicrobial resistance is a challenge all over the world. Although antibiotic stewardship is recommended by the Brazilian government, data regarding antibiotic use in Brazilian hospitals are scarce. The aim of this study was to conduct a point prevalence survey of antimicrobial use in 18 Brazilian hospitals. METHODS: Eighteen Brazilian hospitals conducted the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) in 2017. The study enrolled inpatients on antimicrobials. Data collection included details on the antimicrobial prescriptions. A web-based programme was used for data-entry, validation and reporting. The Global-PPS was developed by the University of Antwerp and bioMérieux provided funding support. FINDINGS: A total of 1801 patients were evaluated, of which 941 (52.2%) were on antimicrobials. Four hundred (42.5%) patients were given at least two antimicrobials. Out of the 1317 antibacterials for systemic use, 514 (39%) were prescribed for community-acquired infections, 533 (40.5%) for healthcare-associated infections and 248 (18.8%) for prophylactic use. The most frequently used antimicrobials were ceftriaxone (12.8%), meropenem (12.3%) and vancomycin (10.3%). Pneumonia or lower respiratory tract infection was the most common site of infection (29.2%). In general, antimicrobials were given mainly parenterally (91%) and empirically (81.2%). CONCLUSIONS: A high prevalence of antibiotic use was observed in the 18 Brazilian hospitals. The antibiotics were prescribed mainly empirically. Intravenous broad-spectrum antibiotics were the most frequent antimicrobials used, showing that reinforcement of de-escalation strategy is needed. The Global-PPS data can be very useful for monitoring stewardship programmes and intervention.
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Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Utilización de Medicamentos/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos , Brasil , Hospitales , Humanos , Prevalencia , Encuestas y CuestionariosRESUMEN
BACKGROUND: Healthcare-associated infection (HAI) represents a major problem for patient safety worldwide. AIM: To provide an up-to-date picture of the extent, aetiology, risk factors and patterns of infections in intensive care units (ICUs) in 28 Brazilian hospitals of different sizes. METHODS: A one-day point prevalence survey in 2016 enrolled the ICUs of hospitals from the 12 meso-regions in Minas Gerais state, south-east Brazil. Hospitals were classified as university or non-university hospitals. All patients with >48 h of admission to the study ICUs at the time of the survey were included. FINDINGS: In total, 303 patients were studied; of these, 155 (51.2%) were infected and 123 (79.4%) had at least one ICU-acquired infection. The most common ICU-acquired infections were pneumonia (53.0%) and bloodstream infection (27.6%). One hundred and nineteen bacterial isolates were cultured; the most common were Acinetobacter baumannii (27.1%), Pseudomonas aeruginosa (27.1%) and Staphylococcus aureus (39.0%). According to type of infection, the most common pathogens were P. aeruginosa (30.4%) in pneumonia, coagulase-negative staphylococci (23.4%) and Enterobacteriaceae (23.4%) in bloodstream infections, and Enterobacteriaceae (47.6%) in urinary tract infections. CONCLUSION: This study found that the overall prevalence of ICU-acquired infections in surveyed Brazilian hospitals was higher than that reported in most European countries and the USA. A greater proportion of infections were caused by non-fermenting Gram-negative bacteria. These observations, along with a high rate of antimicrobial use, illustrate the urgent need for HAIs to be a priority in the public health agenda of Brazil.
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Infecciones Bacterianas/epidemiología , Candidiasis/epidemiología , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Brasil/epidemiología , Candida/aislamiento & purificación , Candidiasis/microbiología , Candidiasis/patología , Niño , Infección Hospitalaria/microbiología , Infección Hospitalaria/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
Pressure ulcers (PU) are the source of multiple complications and even death. To our knowledge, there is no available data about PU prevalence in Mexico. The objective of this study was to determine the point prevalence of PU in three second-level hospitals in Mexico. Every adult hospitalised patient was included in each hospital. Age, gender, hospitalisation ward, Braden score, and the number, location and stage of the ulcers encountered were recorded, as well as any pressure relief measures. In total, 294 patients were examined (127 were male); of these, 63 were considered to be at risk. The average age was 48·6 years. The overall prevalence of the PU was 17%. The service with the highest prevalence was the ICU. The most frequent stage was II (32%) and they were most commonly found in the sacrum (74%). The average Braden score of the patients with ulcers was 10, and 21·4% of the patients obtained moderate- to high-risk Braden scores. Of them, 60·3% had ulcers and only 46% had any preventive measures. The prevalence of PU in three hospitals in Mexico is 17%. The most common stage is II and the most commonly affected site is the sacrum. Only 46% of patients with PU had at least one pressure release measure.