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This is a case of a kidney transplant recipient who presented with skin lesions, low-grade fevers, and pancytopenia 2 months after his transplant.
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Transplante de Rim , Humanos , Argentina , Transplante de Rim/efeitos adversos , América LatinaAssuntos
Infecções por Citomegalovirus , Transplante de Rim , Transplantes , Humanos , Citomegalovirus , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/prevenção & controle , Transplantados , Antivirais/uso terapêuticoRESUMO
Introduction: Accidents with biological material and cuting/piercing instruments among health professionals have led to increased rates of hospital infection and subsequent patient contamination. Objectives: To compare factors associated with accidents involving biological material among health workers. Methods: This cross-sectional epidemiological study, conducted in 2019-2020, included 229 physicians and non-physicians. Results: The sample was 60.7% physicians and 39.3% non-physicians; 51.5% were women; 48.5% were aged ≥40 years; 55% lived with a partner; 57.6% had a specialist or graduate degree; and 51.5% had ≥ 1 child). he physician group had a higher education level, worked > 1 job, and had a high rate of accidents, in addition to lower rates of pre-employment examinations, specific accident training, and supervisor contact in case of accidents. There was also a positive association in the physician group between accidents, employment length, and operating room experience, while age was inversely correlated with accident risk. Conclusions: Different worker categories had specific risk profiles that involved education level, employment length, a low notification level, and risk underestimation. The results showed that education level and employment length do not guarantee accidents prevention. Both the physician and non-physician groups had significant accident rates and a similar behavior profile when events occurred, including low notification rates and underestimating the risk involved in the accident.
Introdução: Acidentes envolvendo material biológico com instrumentos cortantes e perfurantes entre profissionais de saúde têm sido causa de aumento de infecção hospitalar e, portanto, de contaminação do paciente. Objetivos: Comparar fatores associados ao acidente com material biológico em trabalhadores da saúde. Métodos: Estudo epidemiológico transversal envolvendo 229 profissionais, médicos e não médicos (2019-2020). Resultados: A amostra total foi composta por 229 profissionais (48,1% médicos, 51,9% não médicos, 51,5% mulheres, 48,5% ≥ 40 anos, 55% viviam com companheiro, 57,6% tinham nível educacional de especialização/pós-graduação, 51,5% ≥ um filho). Os profissionais médicos apresentaram maior escolaridade, mais de um emprego e maior proporção de ocorrência de acidentes, bem como menor proporção de exames admissionais, treinamentos específicos e contato com supervisor em casos de acidentes. Ainda, os profissionais médicos apresentaram associação positiva dos acidentes com o tempo de trabalho e o tempo de experiência no bloco cirúrgico, enquanto a idade apresentou relação inversa com as chances de acidentes. Conclusões: Diferentes categorias de trabalho apresentaram perfil específico de riscos envolvendo estudo e tempo de serviço, baixa notificação e risco subestimado. Os resultados deste estudo mostraram que o nível de estudo e o tempo de serviço não foram capazes de garantir a prevenção de acidentes envolvendo material biológico. Além disso, profissionais médicos e não médicos apresentaram não apenas uma incidência significativa de acidentes, mas também um perfil de comportamento semelhante diante do evento, com baixa notificação e risco subestimado do acidente.
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Donor-derived tuberculosis (DD-TB) accounts for less than 5% of TB cases and is considered a rare event. In the transplant setting, the frequency of active TB is estimated to be 20 to 74 times higher than that in the general population, and it is associated with high mortality. In this context, the main strategy to minimize the risk of DD transmission is to identify high-risk donors. Despite screening recommendations, failures may result in a breakdown of safety that ends in the transmission of potentially fatal diseases. This report describes a case of DD-TB and emphasizes communication gaps that may occur between organ procurement organizations and transplant centers. Failure in reporting results, lack of exchanging information regarding recipients from the same donor, and inefficient communication between organ procurement organizations and transplant centers are lacks that may be prevented by a more efficient approach towards screening protocols and communication.
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OBJECTIVE: The use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. METHODS: This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). RESULTS: From 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p=0,005). CONCLUSION: It was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.
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Anti-Infecciosos , Infecções Bacterianas , Infecção Hospitalar , Infecções por Bactérias Gram-Negativas , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Estudos de Coortes , Infecção Hospitalar/tratamento farmacológico , Atenção à Saúde , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Recém-Nascido , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Patients undergoing solid organ transplantation, particularly those who live or have lived in tuberculosis (TB) endemic areas, are at a high risk of developing TB. The majority of post-transplantation TB cases are associated with reactivation of latent TB infection (LTBI). Brazil is in a single position with overlapping areas of high TB endemicity and high transplant activity. In liver transplant (LT), one should be aware of the potential hepatotoxicity associated with the treatment regimens for LTBI. AIM: To evaluate the frequency of LTBI in LT patients and treatment-related issues. METHODS: This was a retrospective analysis of a cohort of cirrhotic patients aged ≥ 18 years, who underwent LT at a high-complexity teaching hospital from January 2005 to December 2012. RESULTS: Overall, 429 patients underwent LT during the study period. Of these, 213 (49.7%) underwent the tuberculin skin test (TST) during the pre-transplant period, and 35 (16.4%) of them had a positive result. The treatment for LTBI was initiated after LT in 12 (34.3%) of the TST-positive patients; in 3 (25.0%), treatment was maintained for at least 6 mo. CONCLUSION: The prevalence of LTBI was lower than expected. Initiation and completion of LTBI treatment was limited by difficulties in the management of these special patients.
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BACKGROUND: Whether active therapy with ß-lactam/ß-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) remains unclear. METHODS: We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL-E BSI onset was the primary and secondary study outcomes, respectively. RESULTS: Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital-acquired BSI (adjusted OR [aOR]: 4.10; 95% confidence interval [CI]: 1.50-11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21-1.77) were independently associated with therapeutic failure at day 7. Age-adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05-1.48), Pitt score (aOR: 1.72; 95% CI: 1.35-2.17), and lymphocyte count ≤500 cells/µL at presentation (aOR: 3.16; 95% CI: 1.42-7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin-tazobactam). Propensity score (PS)-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing vs any other regimen, BLBLI- vs carbapenem-based monotherapy) within the first 72 hours on any of the study outcomes. CONCLUSIONS: Our data suggest that active therapy based on BLBLI may be as effective as carbapenem-containing regimens for ESBL-E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).
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Bacteriemia , Transplante de Rim , Infecções Urinárias , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Carbapenêmicos , Infecções por Enterobacteriaceae/tratamento farmacológico , Humanos , Lactamas , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Inibidores de beta-Lactamases/uso terapêutico , beta-LactamasesRESUMO
During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.
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Hepatite/complicações , Febre Amarela/complicações , Adulto , Hepatite/imunologia , Humanos , Masculino , RecidivaRESUMO
Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.
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Humanos , Masculino , Adulto , Febre Amarela/complicações , Hepatite/complicações , Recidiva , Hepatite/imunologiaRESUMO
INTRODUCTION: The increasing number of transplants performed worldwide and the growing global mobility with migration and travel to and from developing countries and tropical areas are bringing new challenges for the management of transplant infectious diseases, previously less commonly seen, such as Leishmaniasis. However, in this scenario there is a lack of information and the current knowledge is based on a few studies. The selection of the most appropriate treatment depends on various factors, such as patient profile, Leishmania species, disease extent, drug availability, concomitant infections and previous treatments. Therapeutic options may include different formulations of amphotericin B, pentavalent antimonials, miltefosine and paromomycin, among others. These drugs can be used alone or in combination. Areas covered: This review is a practical guide for Visceral Leishmaniasis (VL) specific treatment in solid organ transplant recipients (SOT), including therapeutic options and assessment of therapy response. Expert commentary: The main challenges for treatment of leishmaniasis in SOT recipients are related to the duration of therapy, curative criteria and secondary prophylaxis. Immunosuppression dose reduction is often recommended, but such decisions must be made on an individual basis. At present, Liposomal Amphotericin B is the best choice for treatment and prophylaxis.
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Antiprotozoários/uso terapêutico , Leishmaniose Visceral/tratamento farmacológico , Transplantados , Anfotericina B/uso terapêutico , Animais , Humanos , Imunossupressores/administração & dosagem , Leishmaniose Visceral/parasitologia , Leishmaniose Visceral/prevenção & controle , Transplante de Órgãos , Prevenção Secundária/métodosRESUMO
Abstract Objective: This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. Data source: The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. Data synthesis: A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. Conclusion: Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections.
Resumo Objetivo: Revisão sistemática sobre a densidade de incidência e de fatores de risco para infecção associada a cateter venoso central em população neonatal. Fontes dos dados: Usaram-se os bancos de dados Medline, Embase, Cochrane, Bdenf, Scielo e Lilacs, sem restrição de data ou de idioma. Identificaram-se os estudos que analisaram fatores de risco para infecção da corrente sanguínea em recém-nascidos. Síntese dos dados: Foram encontrados 134 artigos conforme os critérios de elegibilidade. Desses, foram selecionados 14 que abordaram fatores de risco para infecção associada a cateter venoso central em neonatos. A infecção da corrente sanguínea associada a cateter continua a mostrar-se como uma importante complicação, conforme demonstram as taxas de incidência relatadas nos estudos incluídos nesta revisão. Os fatores de risco observados apontam que baixo peso ao nascer, prematuridade e maior tempo de permanência do cateter estão relacionados a maior incidência de infecção da corrente sanguínea. Observou-se que taxas de infecção associada a cateter em valores baixos, próximos a zero, já são uma realidade em instituições de saúde de países desenvolvidos, uma vez que usam programas de vigilância e controle de infecção. Conclusão: A infecção da corrente sanguínea associada a cateter ainda apresenta altas taxas de densidade de incidência em países em desenvolvimento. Destaca-se a necessidade de mais estudos longitudinais e a necessidade de melhores estratégias de prevenção dos fatores de risco para a redução de infecção associada a cateter.
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Humanos , Recém-Nascido , Cateterismo Venoso Central/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Incidência , Fatores de Risco , Infecções Relacionadas a Cateter/etiologiaAssuntos
Antiprotozoários/uso terapêutico , Seleção do Doador/métodos , Leishmania donovani/efeitos dos fármacos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Transplante de Órgãos/métodos , Doadores de Tecidos , Transplantados , Antiprotozoários/efeitos adversos , Seleção do Doador/normas , Interações Hospedeiro-Parasita , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , América Latina , Leishmania donovani/isolamento & purificação , Leishmania donovani/patogenicidade , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/transmissão , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/parasitologia , Leishmaniose Visceral/transmissão , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/normas , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
The Recommendations for Management of Endemic Diseases and Travel Medicine in Solid-Organ Transplant Recipients and Donors: Latin America clinical practice guideline is intended to guide clinicians caring for solid-organ transplant (SOT) donors, candidates and recipients regarding infectious diseases (ID) issues related to this geographical region, mostly located in the tropics. These recommendations are based on both systematic reviews of relevant literature and expert opinion from both transplant ID and travel medicine specialists. The guidelines provide recommendations for risk evaluation and laboratory investigation, as well as management and prevention of infection of the most relevant endemic diseases of Latin America. This summary includes a brief description of the guideline recommendations but does not include the complete rationale and references for each recommendation, which is available in the online version of the article, published in this journal as a supplement. The supplement contains 10 reviews referring to endemic or travel diseases (eg, tuberculosis, Chagas disease [ChD], leishmaniasis, malaria, strongyloidiasis and schistosomiasis, travelers diarrhea, arboviruses, endemic fungal infections, viral hepatitis, and vaccines) and an illustrative section with maps (http://www.pmourao.com/map/). Contributors included experts from 13 countries (Brazil, Canada, Chile, Denmark, France, Italy, Peru, Spain, Switzerland, Turkey, United Kingdom, United States, and Uruguay) representing four continents (Asia, the Americas and Europe), along with scientific and medical societies.
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Doenças Endêmicas , Infecções/terapia , Guias de Prática Clínica como Assunto , Doadores de Tecidos , Transplantados , Medicina de Viagem , Humanos , América LatinaRESUMO
OBJECTIVE: To describe the profile of reported healthcare-associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center. METHODS: Retrospective cohort of pediatric patients who were submitted to HSCT from 2008 to 2016. The criteria for HAI were based on those established by the National Healthcare Safety Network. Data were collected by active surveillance performed daily by professionals. This study was approved by the institutional research ethics committee. RESULTS: A total of 86 HSCTs were performed in 81 patients younger than 18 years of age (median, 10 years). Of these, 69 (85%) were males. Aplastic anemia and leukemia were the main diagnoses. A total of 140 HAIs were diagnosed with an incidence density of 28.2 infections/1000 patient-days. The most common HAI was laboratory-confirmed bloodstream infection (46), the majority of which was reported to be central venous catheter-associated (43). Gram-negative bacteria were the most prevalent microorganisms (58.5%). Almost all the infections occurred until 30 days after transplantation, and 17 deaths were observed within 180 days after the procedure. CONCLUSION: Active surveillance of HAIs in HSCT children allowed the evaluation of the incidence and profile of HAIs, which is essential for the health care of these patients.
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Infecção Hospitalar/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções/epidemiologia , Infecções/etiologia , Transplantados , Adolescente , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Incidência , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. DATA SOURCE: The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. DATA SYNTHESIS: A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. CONCLUSION: Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections.
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Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecções Relacionadas a Cateter/etiologia , Humanos , Incidência , Recém-Nascido , Fatores de RiscoRESUMO
ABSTRACT Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) is an important cause of nosocomial infections especially in intensive care units. This study aimed to assess clinical aspects and the genetic background of CRAb among ICU patients at a Brazilian teaching hospital. Methods: 56 critically ill patients colonized or infected by CRAb, during ICU stay, were prospectively assessed. Based on imipenem MIC ≥ 4 µg/mL, 28 CRAB strains were screened for the presence of genes encoding metallo-β-lactamases and OXA-type β-lactamases. The blaOXA-type genes were characterized by PCR using primers targeting ISAba-1 or -3. Genetic diversity of blaOXA-positive strains was determined by ERIC-PCR analysis. Results: Patient's mean age (±SD) was 61 (±15.1), and 58.9% were male. Eighty-percent of the patients presented risk factors for CRAb colonization, mainly invasive devices (87.5%) and previous antibiotic therapy (77.6%). Thirty-three patients died during hospital stay (59.0%). Resistance to carbapenems was associated with a high prevalence of blaOXA-23 (51.2%) and/or blaOXA-143 (18.6%) genes. ERIC-PCR genotyping identified 10 clusters among OXA-producing CRAb. Three CRAb strains exhibited additional resistance to polymyxin B (MIC ≥ 4 µg/mL), whereas 10 CRAb strains showed tigecycline MICs > 2 µg/mL. Conclusions: In this study, clonally unrelated OXA-123- and OXA-143-producing A. baumannii strains in ICU patients were strongly correlated to colonization with infected patients being associated with a poor outcome.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , beta-Lactamases/biossíntese , Infecções por Acinetobacter/microbiologia , Infecção Hospitalar/microbiologia , Acinetobacter baumannii/enzimologia , Antibacterianos/farmacologia , beta-Lactamases/genética , Brasil , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Reação em Cadeia da Polimerase Multiplex , Genótipo , Hospitais de Ensino , Unidades de Terapia IntensivaRESUMO
Abstract Coagulase-negative Staphylococcus has been identified as the main nosocomial agent of neonatal late-onset sepsis. However, based on the pharmacokinetics and erratic distribution of vancomycin, recommended empirical dose is not ideal, due to the inappropriate serum levels that have been measured in neonates. The aim of this study was to evaluate serum levels of vancomycin used in newborns and compare the prediction of adequate serum levels based on doses calculated according to mg/kg/day and m2/day. This is an observational reprospective cohort at a referral neonatal unit, from 2011 to 2013. Newborns treated with vancomycin for the first episode of late-onset sepsis were included. Total dose in mg/kg/day, dose/m2/day, age, weight, body surface and gestational age were identified as independent variables. For predictive analysis of adequate serum levels, multiple linear regressions were performed. The Receiver Operating Characteristic curve for proper serum vancomycin levels was also obtained. A total of 98 patients received 169 serum dosages of the drug, 41 (24.3%) of the doses had serum levels that were defined as appropriate. Doses prescribed in mg/kg/day and dose/m2/day predicted serum levels in only 9% and 4% of cases, respectively. Statistical significance was observed with higher doses when the serum levels were considered as appropriate (p < 0.001). A dose of 27 mg/kg/day had a sensitivity of 82.9% to achieve correct serum levels of vancomycin. Although vancomycin has erratic serum levels and empirical doses cannot properly predict the target levels, highest doses in mg/kg/day were associated with adequate serum levels.