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La presencia de infecciones asociadas a la atención en salud (IAAS) se han constituido en un problema de salud para todos los establecimientos salud, siendo los reservorios uno de los factores más importantes en su presencia y continuidad hospitalaria. Por lo que es necesario una serie de mecanismos para su identificación y control respectivo, siendo uno de ellos el mapeo epidemiológico que permite de por medio de herramientas técnicas la identificación de reservorios en un ambiente hospitalario geográfico específico para toma de acciones preventivas
The presence of associated health care infections (IAAS) have become a health problem for all health programs, with reservoirs that are of the most important factors in their presence and hospital continuity. Therefore, a series of mechanisms are necessary for their respective identification and control; one of them are the epidemiological mapping that allows, through technical tools, the identification of reservoirs in a specific geographic hospital environment for taking preventive actions.
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Reservatórios de Água , Atenção à SaúdeRESUMO
Background: In recent years Staphylococcus epidermidis has been considered an important and frequent causative agent of health care-associated infections (HAIs), increasing the costs of hospitalization, morbidity, and mortality. Antibiotic resistance and biofilm formation are the most important obstacles in the treatment of infections caused by this microorganism. The aim of this work was to determine the most prevalent STs, as well as the antibiotic resistance profile and biofilm formation of S. epidermidis clinical isolates obtained from hospitalized patients in two hospitals in Acapulco, Guerrero in two time periods. Methods: Twenty methicillin-resistant S. epidermidis strains isolated from patients with bacteremia in two hospitals in two time periods were analyzed. Identification and antibiotic susceptibility were performed using the Vitek automated system. Molecular confirmation of the identification and methicillin resistance was performed by duplex PCR of the mecA and nuc genes. Biofilm production was analyzed, and the clonal origin was determined by multilocus sequence typing (MLST). Results: We identified 14 antibiotic resistance profiles as well as 13 sequence types (ST), including the new ST761. We also found that ST2 and ST23 were the most prevalent and, together with ST59, were found in both time periods. Seventeen of our clinical isolates were multidrug-resistant, but all of them were sensitive to linezolid and vancomycin, and this was not related to biofilm production. Additionally, we standardized a duplex PCR to identify methicillin-resistant S. epidermidis strains. In conclusion, S. epidermidis STs 2, 23, and 59 were found in both time periods. This study is the first report of S. epidermidis ST761. The clinical isolates obtained in this work showed a high multidrug resistance that is apparently not related to biofilm production.
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Bacteriemia , Infecção Hospitalar , Infecções Estafilocócicas , Humanos , Staphylococcus epidermidis/genética , Infecções Estafilocócicas/tratamento farmacológico , Tipagem de Sequências Multilocus , Linezolida/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Bacteriemia/tratamento farmacológicoRESUMO
Urinary tract infections (UTIs) are the most common health-care-associated infections (HCAIs) and one of the top-ranking microbial infections. In the community, about 80% of UTIs are caused by uropathogenic Escherichia coli (UPEC), but there is a high variability of etiological agents involved in hospital-acquired UTIs. With this context in mind, the current study aimed to evaluate the prevalence of the main etiological agents responsible for UTIs and their susceptibility profile at the Hospital das Clínicas de Ribeirão Preto, a high complexity reference hospital in the Southeast region of Brazil. This retrospective and descriptive study analyzed all positive inpatient cultures [100,000 colony-forming unit (CFU)/mL] from November 2016 to April 2017. The most prevalent microorganism was Kleb-siella pneumoniae (23 isolates), equivalent to 37.7% of positive urocultures. The second most prevalent agent was UPEC, with 19 isolates (31.1%). The risk factors evaluated in these inpatients showed that 17.5% underwent a uro-logical procedure on admission, 31.6% were using a urinary catheter; 26.2% were using immunosuppressive drugs during the period in which the clinical diagnosis was made. Our results demonstrate the prevalence of UTI causes in the hospital context and the main risk factors for them and will be pretty helpful in guiding empirical treatment in severe UTIs inside the hospital as well as reflect on the actual need and time duration of invasive procedures in the hospital environmen (AU)
As infecções do trato urinário (IU) são a terceira causa principal de infecções associadas ao ambiente hospitalar, logo após as infecções pulmonares e da corrente sanguínea. Na comunidade, cerca de 80% das IU são causadas por E. coli, mas há uma alta variabilidade de agentes etiológicos envolvidos nas IU hospitalares. Este estudo visa avaliar a prevalência dos principais agentes etiológicos e perfil de suscetibilidade envolvidos em IU em um am-biente hospitalar de referência de alta complexidade no sul do Brasil. Este é um estudo retrospectivo e descritivo que analisou todas as culturas positivas (100.000 ufc/ml) de pacientes nas enfermarias de um hospital terciário no período entre novembro de 2016 a abril de 2017. O microorganismo mais prevalente foi Klebsiella pneumoniae (23 isolados), o que equivale a 37,7% das uroculturas. O segundo agente mais prevalente foi Escherichia coli, com 19 isolados (31,1%). Os fatores de risco avaliados nestes pacientes mostraram que 17,5% foram submetidos a um procedimento urológico na admissão, 31,6% estavam usando um cateter urinário; 26,2% estavam usando drogas imunossupressoras no período em que o diagnóstico clínico foi feito. Nossos resultados demonstram uma mudança importante na prevalência das causas de IU no contexto hospitalar e os principais fatores de risco para elas e serão bastante úteis para orientar o tratamento empírico em IU grave dentro do hospital, bem como refletir sobre a real necessidade e a duração dos procedimentos invasivos no ambiente hospitalar (AU)
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Humanos , Infecções Urinárias , Escherichia coli , Cateteres Urinários , Imunossupressores , Klebsiella pneumoniaeRESUMO
INTRODUCTION: The increasing resistance to antibiotics is a public health problem and an imminent therapeutic challenge in hospitals. In this report we aimed to analyze the relationship between antimicrobial resistance and antibiotic consumption in a third-level pediatric hospital. METHODOLOGY: A cross-sectional analysis was conducted using the information from the microbiology and pharmacy databases of the Pediatric Hospital "Doctor Silvestre Frenk Freund", during the period 2015-2018. Prevalence of antimicrobial resistance by microorganisms and dispensed grams of selected antibiotics were calculated annually. Antibiotic resistance trend over the time was evaluated using the Chi-square trends test and to assess the correlation between the dispensed grams of antibiotics with their antimicrobial resistance prevalence, we calculated the Pearson's coefficient (r). RESULTS: A total of 4,327 isolated bacterial samples were analyzed (56.5% Gram-positive and 44.5% Gram-negative). Most frequently isolated microorganisms were coagulase-negative staphylococci (CoNS), E. coli, K. pneumoniae, P. aeruginosa and S. aureus. We found a significant increase in resistance to clindamycin and oxacillin for CoNS and significant decrease in nitrofurantoin and amikacin resistance for E. coli and K. pneumoniae. We observed a strong positive and statistically significant correlation between amikacin resistance prevalence and amikacin dispensed grams for P. aeruginosa (r = 0.95, p = 0.05). CONCLUSIONS: The antibiotic resistance profile showed by our study highlights the need of an appropriate antibiotic control use in the Hospital setting.
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Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Hospitais Pediátricos/estatística & dados numéricos , Antibacterianos/farmacologia , Gestão de Antimicrobianos , Criança , Estudos Transversais , Humanos , México , Testes de Sensibilidade MicrobianaRESUMO
RESUMEN Objetivos. Determinar el nivel de conocimientos y prácticas sobre las medidas de prevención de las infecciones asociadas a la atención de salud (IAAS) y sus factores asociados en médicos residentes ingresantes 2018 de una universidad de Lima, Perú. Métodos. Estudio transversal en el cual se aplicó un cuestionario validado a 171 médicos residentes. Las variables estudiadas fueron edad, sexo, tiempo como profesional, capacitaciones previas, procedencia, tipo de universidad de procedencia, entre otras. Resultados. 52% de los participantes fueron de sexo femenino, el 49% tenía 2 o menos años de tiempo como profesional médico, el 49% provenía de una universidad del interior del país, solo el 34% ocupó una vacante cautiva y el 71,9% tuvo capacitaciones previas sobre medidas de prevención de IAAS. El 83% de los médicos residentes ingresantes estudiados mostró poco conocimiento sobre medidas de prevención de las IAAS mientras que el 68,4% mostró prácticas no adecuadas sobre medidas de prevención de las IAAS. El ingreso a una especialidad de medicina estuvo asociado a un menor riesgo de tener poco conocimiento (OR: 0,32, IC 95%: 0,11-0,93). El mayor tiempo como profesional se relacionó a un menor riesgo de tener prácticas inadecuadas (OR: 0,936, IC 95%: 0,89-0,99). Conclusiones. Existe un bajo nivel de conocimientos sobre medidas de prevención de IAAS y una elevada proporción de los residentes ingresantes 2018 tuvo prácticas no adecuadas sobre medidas de prevención de IAAS. Se observó que el tipo de especialidad fue un factor asociado al nivel de conocimientos y el tiempo de experiencia profesional fue un factor asociado al tipo de práctica.
ABSTRACT Objectives. To determine level of knowledge and practices on the measures of prevention of infections associated with health care (HAI) and factors associated with in incoming resident physicians 2018 of a university of Lima, Peru. Methods. A validated questionnaire was applied to 171 resident physicians in a cross-sectional study. Variables studied were age, sex, time as a professional, previous training, origin, type of university of origin, among others. Results. It was observed that 52% are female, 49% had 2 or less years as a medical professional, 49% came from a university in the interior of the country, only 34% occupied a captive vacancy and 71.9% had previous training on HAI prevention measures. 83% of the incoming resident physicians studied showed a low level of knowledge about HAI prevention measures while 68.4% of the incoming resident physicians studied showed inappropriate practices on HAI prevention measures. When performing the multivariate analysis, it showed that entering a medicine specialty was associated with a lower risk of having low level of knowledge (OR: 0.32, 95% CI: 0.11-0.93). The bivariate analysis showed that the longest time as a professional was related to lower risk of having inappropriate practices, this being confirmed when performing the multivariate analysis (OR: 0.936, 95% CI: 0.89-0.99). Conclusions. There is a low level of knowledge about HAI prevention measures and a high proportion with inappropriate practices in incoming residents 2018 on HAI prevention measures. It was observed that the type of specialty is a factor associated with the level of knowledge and the time of professional experience is a factor associated with the type of practice.
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BACKGROUND: Pediatric hematopoietic stem cell transplantation (HSCT) recipients represent a vulnerable population with regard to health care-associated infections (HAI) with a differentiated profile of etiologic agents.1,2 There are few reports in the literature regarding HAI in the pediatric population submitted to HSCT. METHODS: This is a retrospective study conducted in a pediatric HSCT unit in Curitiba, Brazil between February 2013 and December 2017 that evaluated 109 pediatric patients. The variables analyzed were: age, gender, baseline disease, type of transplantation, infection topography, etiologic agent, time of HAI occurrence, antimicrobial prophylaxis, period of neutropenia, length of stay, and outcomes RESULTS: Of 113 HSCT procedures, 91 (83.5%) were allogenic and 18 were autologous (16.5%). The mean age of the patients was 7.9 years, with a median of 8.1 years (4.0 months-17.3 years); 71 (65.1%) were male; 55 (50.5%) presented with an oncologic diagnosis, 32 (29.4%) with a hematological diagnosis, 17 (15.6%) with immunodeficiencies, and 5 (4.6%) with other causes. During hospitalization after HSCT, 86 episodes of HAI were detected in 66 patients, with an infection density of 16.5 infections/1000 patient days, 86% of which occurred after allogeneic transplants, appearing, on average, 15.3 days after transplantation. The main topographies were bloodstream infection (BSI), with 24 (27.9%) cases, and central line-associated bloodstream infection (CLABSI), with 11 (12.8%). Gram-positive bacteria predominated in cultures and HAI was more frequent in patients diagnosed with immunodeficiencies and other non-oncologic and non-hematologic conditions. Among the Gram-positive bacteria, Staphylococcus epidermidis was the main agent identified (77.7%), possibly because of colonization. However, Gram-negative bacteria, with a resistance profile, comprised 40% of the cases of bacterial infections, most of them represented by Klebsiella pneumoniae (66.6%). Of the 66 patients who presented HAI, 59 patients (89.4%) were discharged, and 7 (10.6%) died. CONCLUSION: The main topographies were CLABSI and BSI. Patients with immunodeficiencies presented a higher risk for HAI Staphylococcus epidermidis was the main agent identified. However, Klebsiella pneumoniae posed a higher risk for Pediatric Intensive Care Unit admission and death.
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Bacteriemia , Transplante de Células-Tronco Hematopoéticas , Brasil , Criança , Atenção à Saúde , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: Surgical site infections (SSIs) are among the leading health care-associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. METHODS: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. RESULTS: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index (P = .041), prolonged surgery time (P = .043), and prolonged duration of chest drain placement (P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status (P = .05) and positive bronchoalveolar lavage (P < .001). Having an SSI was associated with an increased length of stay in intensive care units (P = .003), reoperation (P = .014), and a higher 1-year mortality rate (P = .02). CONCLUSIONS: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.
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Anti-Infecciosos/uso terapêutico , Transplante de Pulmão/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Transplantados/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Rationale: Coated devices may reduce biofilm formation and reduce the occurrence of device-related infections in critically ill patients. A bundle of coated devices (an endotracheal tube [ETT], central venous catheter [CVC], and urinary catheter [UC]) simultaneously inserted may optimize benefits of coated devices in patients with the most severe illness.Objectives: To assess the feasibility of a randomized controlled trial on simultaneous insertion of gold/silver/palladium-coated devices versus uncoated devices in severely ill patients, which required sequential insertion of all three devices (an ETT, CVC, and UC) for support in the intensive care unit (ICU).Methods: This was a multicenter randomized controlled pilot trial. Patients who required simultaneous insertion of an ETT, CVC, and UC were randomized to treatment with coated versus uncoated devices, which were used as necessary for up to 28 days. The primary endpoint was feasibility, defined as the trial being able to enroll enough participants to have the sample size necessary for its secondary primary endpoint (estimating sepsis incidence in this population) in less than 1 year and for estimating the number of admitted patients who require simultaneous insertion of all three devices. Secondary endpoints included the incidence of sepsis and device-associated infections (ventilator-associated pneumonia, catheter-related bloodstream infection, and catheter-related urinary-tract infection) within each group as well as the number of days alive and free of antibiotics during the ICU stay. All events were adjudicated.Results: One hundred and three patients (48 in the coated-device group and 55 in the uncoated-device group) were included in the per-protocol analysis. The inclusion period was 8 months. There were 13 septic events in each group (26 in total), with an approximate incidence of sepsis of 32.3 (95% credible interval [CrI], 22.4-44.9) per 100 patient-days. The overall incidences of ventilator-associated pneumonia, catheter-related urinary-tract infection, and catheter-related bloodstream infection were 15.2 (95% CrI, 7.8-26.4), 6.3 (95% CrI, 2.4-13.7), and 7.9 (95% CrI, 3.6-15.1) per 1,000 patient-days, and incidence rates were not statistically different between groups. Patients in the coated-device group had more days alive and free of antibiotics in the ICU (28.97 d vs. 19.62 d per 100 patient-days; mean ratio, 1.48; 95% CrI, 1.16-1.89).Conclusions: Use of a bundle of coated devices as the initial treatment for of severely ill patients is feasible. Coated devices may be associated with more days alive and free of antibiotics.Clinical trial registered with www.clinicaltrials.gov (NCT03868241).
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Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Infecção Hospitalar , Pneumonia Associada à Ventilação Mecânica , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Unidades de Terapia Intensiva , Projetos Piloto , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controleRESUMO
Conocer el rol del medio ambiente es fundamental para evitar las infecciones intra-hospitalarias. Con ese objetivo, se planteó evaluar la prevalencia de contaminación ambiental por microorganismos multirresistentes (MMR) antes y después de la limpieza terminal de habitaciones de pacientes colonizados y establecer si la aparatología de uso común actuaba como reservorio de estos en la unidad de cuidados intensivos (UTI). Se obtuvieron muestras ambientales de las habitaciones, 48 h posteriores a la detección de colonización y luego de las limpiezas. Los resultados mostraron que luego de ambos procedimientos de limpieza se logró reducir de 28,2% a 2,6% la contaminación por Acinetobacter spp. multirresistente (AMR). También, se tomaron muestras de aparatología de uso común encontrándose entre 1,8 y 5,4% de contaminación por MMR. La limpieza y desinfección reducen significativamente la contaminación ambiental. Sin embargo, la colonización de equipos por MMR y el incumplimiento de precauciones universales representan una posibilidad de transmisión cruzada.
It is essential to understand the role of the environment in order to avoid intrahospital infections. To achieve this objective, this research proposes to assess the prevalence of the environmental contamination caused by multi-resistant microorganisms (MRM) before and after terminal disinfection in rooms with colonized patients, but also to establish whether the commonly used device acts as a reservoir of those micro-organisms in an intensive care unit (ICU). Environmental samples were obtained from the rooms, 48 hours after detecting colonization and also after the first and second final cleaning. The results showed that after both procedures, there was a reduction from 28.2% to 2.6% of contamination caused by multi-resistant Acinetobacter spp. (AMR). Samples from appliances and supplies were taken as well, in which case, between 1.8 and 5.4% of contamination levels induced by MMR were found. Cleaning and disinfecting significantly reduce environmental contamination. However, both MMR bacterial colonization and the lack of universal precautions enforcement represent a possibility of cross-transmission.
É essencial conhecer o papel do meio ambiente para evitar as infecções intra-hospitalares. Com esse objetivo, planejou-se avaliar a prevalência de contaminação ambiental por microorganismos multirresistentes (MMR) antes e depois da limpeza final dos quartos de pacientes colonizados e estabelecer se os aparelhos de uso comum atuavam como um reservatório deles na unidade de terapia intensiva (UTI). Obtiveram-se amostras ambientais dos quartos 48 horas após a detecção da colonização e logo após as limpezas finais. Os resultados mostraram que depois dos dois procedimentos de limpeza se obteve uma redução de 28,2% para 2,6% da contaminação por Acinetobacter spp. multirresistente (AMR). Foram obtidas também amostras de aparelhos de uso comum onde se encontraram entre 1,8% e 5,4% de contaminação por MMR. A limpeza e a desinfecção reduzem significativamente a contaminação ambiental. Contudo, a colonização de equipamentos por MMR e o não cumprimento de providências universais representam uma possibilidade de transmissão cruzada.
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Humanos , Acinetobacter , Acinetobacter/patogenicidade , Desinfecção , Poluição Ambiental , Poluição Ambiental/prevenção & controle , Zeladoria Hospitalar , Zeladoria Hospitalar/ética , Unidades de Terapia Intensiva , Pesquisa , Papel (figurativo) , Quartos de Pacientes , Monitoramento Ambiental/métodos , Prevalência , Meio Ambiente , Zeladoria Hospitalar/normas , Infecções , MétodosRESUMO
BACKGROUND: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. METHODS: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. RESULTS: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum ß-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). CONCLUSIONS: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.
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Transplante de Fígado , Infecção da Ferida Cirúrgica/epidemiologia , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/etiologia , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/isolamento & purificação , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Prontuários Médicos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/mortalidadeRESUMO
Bio-artificial polymeric systems are a new class of polymeric constituents based on blends of synthetic and natural polymers, designed with the purpose of producing new materials that exhibit enhanced properties with respect to the individual components. In this frame, a combination of polyvinyl alcohol (PVA) and chitosan, blended with a widely used antibiotic, sodium ampicillin, has been developed showing a moderate behavior in terms of antibacterial properties. Thus, aqueous solutions of PVA at 1 wt.% were mixed with acid solutions of chitosan at 1 wt.%, followed by adding ampicillin ranging from 0.3 to 1.0 wt.% related to the total amount of the polymers. The prepared bio-artificial polymeric system was characterized by FTIR, SEM, DSC, contact angle measurements, antibacterial activity against Staphylococcus aureus and Escherichia coli and antibiotic release studies. The statistical significance of the antibacterial activity was determined using a multifactorial analysis of variance with ρ < 0.05 (ANOVA). The characterization techniques did not show alterations in the ampicillin structure and the interactions with polymers were limited to intermolecular forces. Therefore, the antibiotic was efficiently released from the matrix and its antibacterial activity was preserved. The system disclosed moderate antibacterial activity against bacterial strains without adding a high antibiotic concentration. The findings of this study suggest that the system may be effective against healthcare-associated infections, a promising view in the design of novel antimicrobial biomaterials potentially suitable for tissue engineering applications.
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Ampicilina , Antibacterianos , Quitosana , Escherichia coli/crescimento & desenvolvimento , Álcool de Polivinil , Staphylococcus aureus/crescimento & desenvolvimento , Ampicilina/química , Ampicilina/farmacologia , Antibacterianos/síntese química , Antibacterianos/química , Antibacterianos/farmacologia , Quitosana/química , Quitosana/farmacologia , Álcool de Polivinil/química , Álcool de Polivinil/farmacologiaRESUMO
BACKGROUND: Health care-associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta-analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults. METHODS: Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009-2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta-analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27-2.44), immunosuppression (RR, 1.24; 95% CI, 1.04-1.47), body temperature (MD, 0.62; 95% CI, 0.41-0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17-46.89), reoperation (RR, 7.94; 95% CI, 5.49-11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30-2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91-5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79-7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81-22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28-26.73). CONCLUSIONS: Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.
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Infecção Hospitalar/epidemiologia , Adulto , Infecção Hospitalar/prevenção & controle , Hospitalização , Humanos , Unidades de Terapia Intensiva , Respiração Artificial , Fatores de RiscoRESUMO
Introducción: Las infecciones asociadas a la atención de salud (IAAS) son uno de los principales problemas que afecta a los pacientes en las unidades hospitalarias, tanto en países desarrollados como carentes de recursos. Objetivo: Identificar los tipos de IAAS reportadas, microorganismo causal y susceptibilidad antimicrobiana en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico "Manuel Fajardo". Material y método: Estudio descriptivo, retrospectivo y transversal de 105 pacientes con IAAS, quienes ingresaron en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico Manuel Fajardo, desde enero 2013 hasta diciembre 2015. Se analizaron distintas variables. Se utilizó la estadística descriptiva y se relacionó la información nacional e internacional con los resultados obtenidos. Resultados: Predominaron los pacientes con edad superior a los 60 años. El diagnóstico más común fue la bronconeumonía en 58 pacientes (55.2 por ciento). El principal microorganismo causal para la bronconeumonía, la traqueobronquitis y las úlceras de presión fue Pseudomona spp.; mientras que para la infección del tracto urinario y flebitis-celulitis y absceso fueron E. coli y S. aureus respectivamente. Pseudomona spp. y E. coli mostraron alta resistencia a las cefalosporinas de primera, segunda y tercera generaciones testadas y a otros tipos de antibióticos; sin embargo, para los aminoglucósidos y Cefepime la sensibilidad fue favorable. La susceptibilidad de S. aureus mostró resultados muy adversos, pues solo para la Amikacina y Vancomicina tuvo aceptable sensibilidad. Conclusiones: Las IAAS predominaron en una población envejecida y fueron ocasionadas por una diversidad de microorganismos, principalmente Pseudomona spp., E. coli y S. aureus, los cuales mostraron elevada resistencia antimicrobiana(AU)
Introduction: The health care associated infections (HCAI) are one of the major problems which affect the patients in the hospital units, both in developed countries and in countries with low resources. Objective: To identify what kind of HCAI were reported, causal microorganism and antimicrobial susceptibility in the Internal Medicine Service at the "Manuel Fajardo" clinical-surgical hospital. Material and method: Descriptive, retrospective and transversal study of 105 patients with HCAI, who were admitted in the Internal Medicine Service at the Manuel Fajardo clinical-surgical hospital, from January 2013 to December 2015. It was analyzed different variables. It was used descriptive statistics and it was related the national and international information with the obtained results. Results: It were predominated the patients with age over 60 years. The more common diagnosis was broncho-pneumonia in 58 patients (55.2 percent). The principal causal microorganism for broncho-pneumonia, the tracheo-bronchitis and the pressure ulcers was Pseudomona spp.; while for urinary tract infection and flebitis-cellulitis and abscess were E. coli and S. aureus respectively. Pseudomona spp. and E. coli showed high resistance to cephalosporins of the first, second and third generation tested and other kinds of antibiotics; however, for the amynoglucosides and for Cefepime the sensibility was favourable. The susceptibility of S. aureus showed very adverse results, because only for Amikacin and Vancomicin had acceptable sensibility. Conclusions: The HCAI predominated in an aged population and were caused by a diversity of microorganisms, principally Pseudomona spp., E. coli and S. aureus, which showed high antimicrobial resistance(AU)
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Humanos , Masculino , Feminino , Infecção Hospitalar/epidemiologia , Anti-Infecciosos/imunologia , Epidemiologia Descritiva , Estudos Transversais , Estudos Retrospectivos , Anti-InfecciososRESUMO
BACKGROUND: Studies have consistently shown that copper alloyed surfaces decrease the burden of microorganisms in health care environments. This study assessed whether copper alloy surfaces decreased hospital-associated infections in pediatric intensive and intermediate care units. METHODS: Admitted infants were assigned sequentially to a room furnished with or without a limited number of copper alloyed surfaces. Clinical and exposure to intervention data were collected on a daily basis. To avoid counting infections present prior to admission, patients who stayed in the hospital <72 hours were excluded from analysis. Health care-associated infections (HAIs) were confirmed according to protocol definitions. RESULTS: Clinical outcomes from 515 patients were considered in our analysis: 261 patients from the intervention arm of the study, and 254 from the control arm. Crude analysis showed an HAI rate of 10.6 versus 13.0 per 1,000 patient days for copper- and non-copper-exposed patients, respectively, for a crude relative risk reduction (RRR) of 0.19 (90% confidence interval, 0.46 to -0.22). Conducting clinical trials to assess interventions that may impact HAI rates is very challenging. The results here contribute to our understanding and ability to estimate the effect size that copper alloy surfaces have on HAI acquisition. CONCLUSIONS: Exposure of pediatric patients to copper-surfaced objects in the closed environment of the intensive care unit resulted in decreased HAI rates when compared with noncopper exposure; however, the RRR was not statistically significant. The clinical effect size warrants further consideration of this intervention as a component of a systems-based approach to control HAIs.
Assuntos
Anti-Infecciosos/farmacologia , Cobre/farmacologia , Infecção Hospitalar/prevenção & controle , Fômites/microbiologia , Unidades de Terapia Intensiva Pediátrica , Instituições para Cuidados Intermediários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
In recent years, there has been increased interest in measuring the climate for infection prevention; however, reliable and valid instruments are lacking. This study tested the psychometric properties of the Leading a Culture of Quality for Infection Prevention (LCQ-IP) instrument measuring the infection prevention climate in a sample of 972 infection preventionists from acute care hospitals. An exploratory principal component analysis showed that the instrument had structural validity and captured 4 factors related to the climate for infection prevention: Psychological Safety, Prioritization of Quality, Supportive Work Environment, and Improvement Orientation. LCQ-IP exhibited excellent internal consistency, with a Cronbach α of .926. Criterion validity was supported with overall LCQ-IP scores, increasing with the number of evidence-based prevention policies in place (P = .047). This psychometrically sound instrument may be helpful to researchers and providers in assessing climate for quality related to infection prevention.
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Infecção Hospitalar/prevenção & controle , Cultura Organizacional , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Humanos , Psicometria , Qualidade da Assistência à Saúde/organização & administração , Estados UnidosRESUMO
Objective: To describe the microorganisms present on surface areas of surgical rooms, in a medium-sized hospital in Sao Paulo state (Brazil). Materials and method: Sixty samples were collected with the aid of sterile swabs soaked in peptone water and rubbed into quadrants of 20 cm 2 . The surfaces investigated were: medication tables, surgical tables, marble countertops and air conditioning grilles. Results: Staphylococcus aureus , coagulase negative, was the microorganism most frequently found on the surgical tables and on the medication tables (50.7% of the samples). This microorganism is also the most frequent cause of post-surgical infection at the same hospital. Conclusions: Prophylactic measures should include proper hand washing, the use of personal protective equipment, appropriate uniforms, and cleaning and sterilization of surface and medical and hospital equipment.
Objetivo: Describir los microorganismos presentes en las superficies del área de quirófanos de un hospital de tamaño medio en el estado de Sao Paulo (Brasil). Materiales y métodos: Se recolectaron y cultivaron 60 muestras con la ayuda de hisopos estériles en agua peptonada y aplicadas sobre cuadrantes de 20 cm 2 . Las superficies investigadas fueron: tabla de medicamentos, mesa operatoria, terminaciones de mármol de la sala y grillas del aire acondicionado. Resultados: El organismo aislado de manera más frecuente fue Staphylococcus aureus coagulasa negativa y se encontró sobre la mesa operatoria y en la mesa de drogas (50,7% de las muestras). Este es el microorganismo reportado como la causa más frecuente de infecciones post-quirúrgicas en el mismo hospital. Conclusiones: Las medidas profilácticas deben incluir un apropiado lavado de manos, uso de equipo personal protector y limpieza y esterilización del equipo médico y hospitalario y de las superficies de trabajo.
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Humanos , Salas Cirúrgicas , Staphylococcus aureus , Esterilização , Poluição Ambiental , Brasil , Vestuário , Equipamentos e Provisões Hospitalares , Equipamento de Proteção Individual , Hospitais , Zeladoria Hospitalar , InfecçõesRESUMO
Introducción: Las infecciones intrahospitalarias se denominan Infecciones Asociadas a Cuidados de la Salud (IACS). Los pacientes quemados tienen un alto riesgo de infección como resultado del inmunocompromiso, estancias intrahospitalarias prolongadas y los procedimientos diagnósticos/terapéuticos requeridos para su manejo. La Unidad de Quemados en 2012 fue el segundo área con mayor tasa de IACS del Hospital del Niño (incidencia 21.2%). Objetivo: Determinar los factores de riesgo para el desarrollo de IACS en pacientes de la Unidad de Quemados del Hospital del Niño de Panamá atendidos desde el año 2009 al 2013. Material y método: Estudio observacional analítico retrospectivo con muestreo probabilístico. Se determinó la frecuencia y fuerza de asociación entre las variables a estudiar y el desarrollo de IACS mediante la prueba de desigualdad relativa (OR) con su intervalo de confianza correspondiente, un nivel de significancia del 95% y precisión de 0.05, previa verificación de la significancia estadística a través de la prueba X2. Resultados: los lactantes, quemaduras de III grado, extensión >10% de SCTQ, número de segmentos corporales quemados, días de estancia hospitalaria, uso de dispositivos invasivos y la realización de procedimientos quirúrgicos son factores de riesgo para el desarrollo de IACS en pacientes quemados. Por otra parte, el uso de coberturas biosintéticas confiere un factor protector. Conclusión: los quemados poseen características endógenas y exógenas para el desarrollo de IACS. Conocer su comportamiento representa una herramienta útil para su control y prevención.
Introduction: Healthcare-associated infections (HAIs) are infections that developed during a hospitalization. Burned patients are at high risk of infection as a result of the immune suppression, long hospital stays and diagnostic / therapeutic procedures required for its management. The Burn Unit on 2012 was the second area with the highest rate of HAIs of the institution (incidence 21.2%). Objective: Determine the risk factors for the development of HAIs in patients in the Burn Unit of Panama Children Hospital since 2009 to 2013. Material and method: A retrospective analytical and observational study with a probabilistic sampling. We determined the frequency and correlations between the variables and the development of HAIs by Odds Ratio (OR) with its corresponding confidence interval, a level of significance of 95% and a precision of 0.05, upon verification of statistical significance through X2. Results: infants, III degree burns, extension above 10% of Burned Body Surface Area, number of compromised body segments, length of hospital stay, use of invasive devices and surgical procedures are risk factors for the development of HAIs in burned patients. On the other hand, the use of burn wound dressings confers a protective factor for them. Conclusion: burned patients have endogenous and exogenous features that allow the development of HAIs. Knowing their behavior represents a useful tool in the control and prevention of them.
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Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.
Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.
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Humanos , Infecção Hospitalar/prevenção & controle , Desinfecção das Mãos/normas , Pessoal de Saúde/educação , Controle de Infecções/métodos , Avaliação de Resultados em Cuidados de Saúde , Colômbia , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Hospitais Universitários , Centros de Atenção TerciáriaRESUMO
Introducción: Staphylococcus aureus resistente a la meticilina (SARM) es responsable de infecciones intrahospitalarias, las que constituyen una importante causa de morbilidad y mortalidad en nuestro medio, por lo cual la rápida identificación y tipificación molecular de la resistencia como el complejo SSCmec es esencial para entender la epidemiología de la infección. Objetivo: Caracterizar fenotípicamente la resistencia a meticilina y genotípicamente el casete cromosomal SSCmec en cepas de S. aureus aislados de individuos de la ciudad de Medellín mediante PCR múltiple. Materiales y métodos: A 41 aislamientos (hospitalarios y de la comunidad) de S. aureus se les estableció la resistencia a cefoxitin mediante la técnica de Kirby-Bauer y la concentración inhibitoria mínima para oxacilina. Mediante PCR convencional se les confirmó la presencia del gen mecA. Para la tipificación del complejo SSCmec se utilizó PCR múltiple para amplificar 6 loci diferentes de este gen. Resultados: A todos los aislamientos se les confirmó resistencia a meticilina y la presencia del gen mecA, de los cuales 17 fueron clasificados como SSC mec I, 1 como SSC mec II, 21 como SSC mecIV; dos aislamientos no fue posible clasificarlos. Conclusiones: Con el uso de esta técnica clasificamos el 95% de los aislamientos del estudio, encontrando una mayor prevalencia de los SSCmec I y IV. La implementación de esta técnica permite una fácil caracterización de los aislamientos SARM y un apropiado manejo de la información de los integrantes de los comités de infecciones hospitalarios, lo cual podría impactar positivamente en el tratamiento a los pacientes y el control de enfermedades infecciosas intrahospitalarias.
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is involved in nosocomial infections, representing an important cause of morbidity and mortality. The rapid identification and molecular classification of resistance, such as the SSCmec complex, is essential to understanding the epidemiology of infection. Objective: To phenotypically characterize methicillin resistance and to genotype the SSCmec complex in S. aureus isolates collected from a cohort of patients from Medellín, Colombia. Materials and Methods: Cefoxtin resistance was evaluated in 41 S. aureus isolates, using the Kirby-Bauer method and determining the minimal bactericidal concentration of oxacillin. To confirm the presence of the mecA gene, conventional PCR was performed. The classification of the SSCmec complex was carried out by multiple PCR, amplifying 6 different loci in this gene. Results: Methicillin resistance and the presence of the mecA gene were confirmed in all isolates. A total of 17 were classified as SSCmec I, one as SSCmec II, and 21 SSCmec IV (only two isolates were not classified). Conclusions: Using this method, it was possible to classify 95% of the studied isolates, with a higher prevalence of SSCmec I and IV. The implementation of this technique allows the characterization of MRSA isolates and an appropriate management of the information by the members of the Hospital Infection Committee. Altogether, this method may have a positive impact on the treatment of patients with MRSA infections.