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In the healthcare sector, the implementation of standardized procedures, such as those commonly employed in franchises to ensure consistent quality, remains underprioritized. Within this framework, we focus on the importance of standardized central venous catheter (CVC) insertion procedures to prevent healthcare-associated outbreaks. While antimicrobial resistance (AMR) may still not be the most prevalent problem in some institutions, its increasing significance certainly underlines the urgency of infection prevention.We aim to highlight this issue by describing and discussing an outbreak scenario of carbapenem-resistant (CR) Pseudomonas fluorescens bloodstream infections resulting from a deviation from the standardized CVC insertion procedure. This outbreak led to six episodes of catheter related bloodstream infection (CRBSI) in patients with hematologic malignancies, delaying their primary treatment. Nineteen patients were exposed, leading to an attack rate of 31.6%.
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Bacteriemia , Infecções Relacionadas a Cateter , Pseudomonas fluorescens , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/epidemiologia , Bacteriemia/epidemiologia , Farmacorresistência Bacteriana , Surtos de Doenças , Padrões de ReferênciaRESUMO
ABSTRACT Objective: To analyze the effect of implementing a bed bath protocol in relation to infection-free time and the prevalence of Healthcare-Associated Infections. Method: A quasi-experimental study with a comparison between two groups. In the Control Group, the data were retrospectively collected between January and April 2018. Implementation of the bed bath protocol in an Intensive Care Unit took place from May to October 2018. Data from the Intervention Group were collected from November 2018 to February 2019 through daily follow-up during the hospitalization period. Results: There were 157 participants in the Control Group and 169 in the Intervention Group, with a mean age of 56 and 54 years old, respectively, and majority of male individuals. The occurrence of Healthcare-Associated Infections was higher in the Control Group (n=32; 20.4%) compared to the Intervention Group (n=10; 5.9%), which presented a 2.86 times lower risk of developing Healthcare-Associated Infections (p<0.01). The Intervention Group presented a longer infection-free time when compared to the Control Group, which had a mean of 2.46 times higher risk of developing infections in the Intensive Care Unit (95%CI: 1.18; 5.11). Conclusion: The study provides support for standardizing the bed bath technique and to preventing health-care associated infections. There is a limitation in generalization of the results, as the groups come from a quasi-experimental before-after design with a non-equivalent Control Group due to the absence of random distribution in the compared groups.
RESUMEN Objetivo: analizar el efecto de implementar un protocolo de higiene de pacientes en la cama en relación con el tiempo sin infección y la prevalencia de Infecciones Relacionadas con la Atención de la Salud. Método: estudio cuasi experimental con comparación entre dos grupos. En el Grupo Control, los datos se recolectaron retrospectivamente entre enero y abril de 2018. La implementación del protocolo de higiene de pacientes en la cama de una Unidad de Cuidados Intensivos tuvo lugar entre mayo y octubre de 2018. Los datos del Grupo Intervención se recolectaron entre noviembre de 2018 y febrero de 2019 por medio del seguimiento diario durante el período de internación. Resultados: hubo 157 participantes en el Grupo Control y 169 en el Grupo Intervención, con una media de edad de 56 y 54 años, respectivamente, y la mayoría del sexo masculino. La incidencia de Infecciones Relacionadas a la Atención de la Salud fue mayor en el Grupo Control (n=32; 20,4%) que en el Grupo Intervención (n=10; 5,9%), y este último presentó 2,86 veces menos riesgo de desarrollar Infecciones Relacionadas a la Atención de la Salud (p<0,01). El Grupo Intervención presentó mayor tiempo sin infección en comparación con el Grupo Control, cuyos participantes tuvieron un promedio de 2,46 veces mayor riesgo de desarrollar infecciones en la Unidad de Cuidados Intensivos (IC95%: 1,18; 5,11). Conclusión: el estudio ofrece aportes para estandarizar la técnica de higiene de pacientes en la cama y prevenir infecciones relacionadas con la atención de la salud. Existe cierta limitación en cuanto a la generalización de los resultados, puesto que los grupos provienen de un diseño cuasiexperimental del tipo "antes-después" con un Grupo Control no equivalente, debido a la ausencia de distribución aleatoria en los grupos comparados.
RESUMO Objetivo: Analisar o efeito da implementação de um protocolo de banho no leito em relação ao tempo livre de infecção e à prevalência de Infecção Relacionada à Assistência à Saúde. Método: Estudo quase experimental, com comparação entre dois grupos. No grupo controle, os dados foram coletados retrospectivamente entre janeiro e abril de 2018. A implementação do protocolo de banho no leito em uma Unidade de Terapia Intensiva ocorreu de maio a outubro de 2018. Os dados do grupo intervenção foram coletados de novembro de 2018 a fevereiro de 2019, por meio do acompanhamento diário durante o período de internação. Resultados: 157 participantes no grupo controle e 169 no grupo intervenção, com média de idade de 56 e 54 anos, respectivamente, sendo a maioria do sexo masculino. A ocorrência de Infecção Relacionada à Assistência à Saúde foi maior no grupo controle (n=32; 20,4%) comparado ao grupo intervenção (n=10; 5,9%), este que apresentou 2,86 menor risco de desenvolver Infecção Relacionada à Assistência à Saúde (p<0,01). O grupo intervenção apresentou maior tempo livre de infecção comparado ao grupo controle, estes que tem, em média, 2,46 vezes maior risco de desenvolver infecção na Unidade de Terapia Intensiva (IC95% 1,18; 5,11). Conclusão: O estudo oferece subsídios para padronização da técnica do banho no leito e prevenção de infecções relacionadas à assistência à saúde. Há limitação na generalização dos resultados, pois os grupos são oriundos de um delineamento quase experimental antes-depois com grupo controle não equivalente, devido à ausência de distribuição aleatória nos grupos comparados.
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Introduction. Carbapenem-resistant Acinetobacter baumannii (CRAB) is the primary pathogen causing hospital-acquired infections. The spread of CRAB is mainly driven by the dissemination of resistant clones, and in Latin America, International Clones IC-1 (also known as clonal complex CC1), IC-4 (CC15) and IC-5 (CC79) are the most prevalent.Gap Statement. There are no documented outbreaks of CRAB International Clone 2 (IC-2) reported in Brazil.Aim. To describe a large outbreak of CRAB caused by the uncommon IC-2 in a Brazilian COVID-19 hospital.Methodology. From May 2020 to May 2021, 224 patients infected or colonized with CRAB were identified in a single hospital; 92â% of them were also infected with SARS-CoV-2. From these patients, 137 isolates were recovered and subjected to antimicrobial susceptibility testing, PCR analysis and molecular typing. Whole-genome sequencing and downstream analysis were carried out on a representative isolate (the first available isolate).Results. In 76â% of the patients, a single OXA-23-producing CRAB IC-2 was identified. All the isolates were susceptible to polymyxin B, but highly resistant (>95â%) to aminoglycosides, fluoroquinolones and beta-lactams. Genomic analysis revealed that the representative isolate also carried the 16S rRNA Methylase ArmA, which was detected for the first time in this species in Brazil.Conclusion. We report the rapid spread of an emerging CRAB clone responsible for causing a large outbreak in a hospital in Brazil, a country with predominance of other CRAB clones. Continuous and prospective surveillance is warranted to evaluate the impact of this clone in Brazilian hospital settings.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , COVID-19 , Infecções por Acinetobacter/epidemiologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Brasil/epidemiologia , COVID-19/epidemiologia , Células Clonais , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Pandemias , Estudos Prospectivos , RNA Ribossômico 16S , SARS-CoV-2/genética , beta-Lactamases/genéticaRESUMO
Introducción: La infección nosocomial o intrahospitalaria constituye un importante problema de salud en todos los hospitales del orbe. Objetivo: Describir las características clínicas y epidemiológicas de pacientes con infecciones intrahospitalarias. Métodos: Se realizó un estudio descriptivo y transversal de 57 pacientes con infecciones intrahospitalarias, ingresados en el Servicio de Medicina Interna del Hospital Provincial Docente Clínico-Quirúrgico Saturnino Lora de Santiago de Cuba, de octubre a diciembre de 2019, para lo cual se analizaron las variables edad, enfermedades asociadas, factores predisponentes, tipo de infección y gérmenes aislados. Resultados: En la serie sobresalieron el grupo etario de 60-69 años y la hipertensión arterial como enfermedad crónica concomitante (26,0 %). Entre los factores predisponentes resultó más frecuente el tabaquismo (32,8 %) y el tipo de infección preponderante fue la bronconeumonía bacteriana (47,0 %), cuyo germen causal en la mayoría de los casos (35,1 %) fue la Klebsiella pneumoniae. Conclusiones: Las infecciones intrahospitalarias aquejaron principalmente a pacientes de edad avanzada con enfermedades crónicas asociadas, como la diabetes mellitus y la hipertensión arterial. Cabe destacar la importancia de conocer la flora microbiana existente en el servicio donde se adquiere la infección, a fin de lograr tanto la prevención como el diagnóstico oportuno y el tratamiento adecuado.
Introduction: The cross or hospital infections constitute an important health problem in all the hospitals of the world. Objective: To describe the clinical and epidemiological characteristics of patients with hospital infections. Methods: A descriptive and cross-sectional study of 57 patients with hospital acquired infections was carried out. They were admitted to the Internal Medicine Service of Saturnino Lora Clinical-surgical Teaching Provincial Hospital of Santiago de Cuba, from October to December, 2019, for which the variables age, associated diseases, predisposing factors, type of infection and isolated germs were analyzed. Results: In the series the 60-69 years age group and hypertension as concomitant chronic disease (26.0 %) were notable. Among the predisposing factors nicotine addiction (32.8 %) was more frequent and the preponderant type of infection was the bacterial bronchopneumonia (47.0 %) whose causal germ in most of the cases (35.1 %) was the Klebsiella pneumoniae. Conclusions: The hospital acquired infections mainly afflicted patients of advanced age with associated chronic diseases, as diabetes mellitus and hypertension. It is necessary to highlight the importance of knowing the existent microbial flora in the service where the infection is acquired, in order to achieve boththe prevention, the opportune diagnosis and the appropriate treatment.
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Infecção Hospitalar , Klebsiella pneumoniae , BroncopneumoniaRESUMO
Emergency department areas were repurposed as intensive care units (ICUs) for patients with acute respiratory distress syndrome during the initial months of the coronavirus disease 2019 (COVID-19) pandemic. We describe an outbreak of New Delhi metallo-ß-lactamase 1 (NDM-1)-producing Escherichia coli infections in critically ill COVID-19 patients admitted to one of the repurposed units. Seven patients developed infections (6 ventilator-associated pneumonia [VAP] and 1 urinary tract infection [UTI]) due to carbapenem-resistant E. coli, and only two survived. Five of the affected patients and four additional patients had rectal carriage of carbapenem-resistant E. coli. The E. coli strain from the affected patients corresponded to a single sequence type. Rectal screening identified isolates of two other sequence types bearing blaNDM-1. Isolates of all three sequence types harbored an IncFII plasmid. The plasmid was confirmed to carry blaNDM-1 through conjugation. An outbreak of clonal NDM-1-producing E. coli isolates and subsequent dissemination of NDM-1 through mobile elements to other E. coli strains occurred after hospital conversion during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This emphasizes the need for infection control practices in surge scenarios. IMPORTANCE The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.
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Infecção Hospitalar/microbiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , beta-Lactamases/metabolismo , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/virologia , Conjugação Genética , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Escherichia coli/classificação , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Plasmídeos/genética , SARS-CoV-2/fisiologia , Centros de Atenção Terciária/estatística & dados numéricos , beta-Lactamases/genéticaRESUMO
We report the isolation and genomic characterization of a VIM-2 producing Pseudomonas chlororaphis causing bloodstream infection in a newborn in Brazil. A new integron, In2088 (intI1-blaVIM-2-aacA7-aacA27-gcu241), was identified and the first P. chlororaphis genome from a clinical isolate was deposited in public databases.
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Infecções por Pseudomonas/microbiologia , Pseudomonas chlororaphis/isolamento & purificação , Sepse/microbiologia , Brasil , Humanos , Recém-Nascido , Integrons/genética , Pseudomonas chlororaphis/enzimologia , Pseudomonas chlororaphis/genética , beta-Lactamases/genéticaRESUMO
Resumen La aparición de la enfermedad por SARS-CoV-2 el año 2020 nos enfrentó a un aumento creciente y exponencial de pacientes con riesgo vital por falla respiratoria catastrófica y multisistémica que deben ser sometidos a ECMO para sobrevivir. Esto ha generado en nuestro país la aparición de Unidades de Tratamiento (ECMO) en hospitales en que antes no se disponía de este recurso o se realizaba como parte de las intervenciones en Unidades de Cuidados Intensivos (UCI), lo que constituye un nuevo desafío a los programas de control y prevención de infecciones de los centros de salud. Dado que al momento de la redacción de este documento no existe normativa nacional específica que se refiera a este tema, se propone un enfoque para prevención, control y vigilancia de infecciones asociadas a atención de salud en pacientes ECMO. Se presenta una revisión de los riesgos específicos a que están expuestos estos pacientes, definiendo qué medidas de prevención se requieren, proponiendo un conjunto de medidas específicas para instalación y mantención, así como orientación respecto de antibioprofilaxis y se sugiere qué eventos infecciosos vigilar.
Abstract The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.
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Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Fatores de Risco , Controle de Infecções , SARS-CoV-2 , COVID-19/terapia , Unidades de Terapia IntensivaRESUMO
Hospital-acquired infections are a global health problem that threatens patients' treatment in intensive care units, causing thousands of deaths and a considerable increase in hospitalization costs. The endotracheal tube (ETT) is a medical device placed in the patient's trachea to assist breathing and delivering oxygen into the lungs. However, bacterial biofilms forming at the surface of the ETT and the development of multidrug-resistant bacteria are considered the primary causes of ventilator-associated pneumonia (VAP), a severe hospital-acquired infection for significant mortality. Under these circumstances, there has been a need to administrate antibiotics together. Although necessary, it has led to a rapid increase in bacterial resistance to antibiotics. Therefore, it becomes necessary to develop alternatives to prevent and combat these bacterial infections. One possibility is to turn the ETT itself into a bactericide. Some examples reported in the literature present drawbacks. To overcome those issues, we have designed a photosensitizer-containing ETT to be used in photodynamic inactivation (PDI) to avoid bacteria biofilm formation and prevent VAP occurrence during tracheal intubation. This work describes ETT's functionalization with curcumin photosensitizer, as well as its evaluation in PDI against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli A significant photoinactivation (up to 95%) against Gram-negative and Gram-positive bacteria was observed when curcumin-functionalized endotracheal (ETT-curc) was used. These remarkable results demonstrate this strategy's potential to combat hospital-acquired infections and contribute to fighting antimicrobial resistance.
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Antibacterianos/farmacologia , Curcumina/farmacologia , Intubação Intratraqueal/instrumentação , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Antibacterianos/química , Biofilmes/efeitos dos fármacos , Curcumina/química , Humanos , Intubação Intratraqueal/efeitos adversos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/fisiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/fisiologiaRESUMO
OBJECTIVE: Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. METHODS: Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. RESULTS: A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23-39.27, OR: 2.48, 95% CI 1.17-5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. CONCLUSION: Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.
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ABSTRACT Introduction: Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible. This study aimed at analyzing associations between PN characteristics and infectious complications in hospitalized patients. Material and methods: This was a retrospective cohort study conducted in a tertiarycare university hospital. Data from consecutive adult patients submitted to PN (January 2016 to December 2017; ICU and ward) were reviewed by means of an electronic database. Patient's clinical characteristics, PN prescription and catheter insertion procedure data were extracted and analyzed. The main outcome was the development of central line-associated bloodstream infection (CLABSI). The secondary outcomes were other infectious complications and mortality, as well as factors associated with CLABSI. Results: We analyzed 165 patients and 247 catheters used for parenteral nutrition infusion. The CLABSI rate was 6.47 per 1000 catheter-days. In the univariable analysis, CLABSI was associated with longer hospitalization time, longer PN time, longer catheter time, catheter insertion performed by a surgeon or a surgical resident, and procedures performed outside the ICU. In an extended time-dependent Cox regression, no variable was associated with a higher risk of CLABSI, and additional PN days did not increase the rate of CLABSI. The overall mortality rate was 24.8%. Only the patients' comorbidity index was associated with death in the multivariable analysis. Discussion: In our study, patients who needed PN had an overall CLABSI rate of 6.47 per 1000 catheter-days. These outcomes were not associated with PN and catheter characteristics studied after adjustment for catheter time. The overall mortality rate was 24.8% and it was not associated with PN in multivariable analyses, only with Charlson comorbidity index.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cateterismo Venoso Central/efeitos adversos , Nutrição Parenteral/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Relacionadas a Cateter/diagnóstico , Unidades de Terapia IntensivaRESUMO
INTRODUCTION: Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible. This study aimed at analyzing associations between PN characteristics and infectious complications in hospitalized patients. MATERIAL AND METHODS: This was a retrospective cohort study conducted in a tertiarycare university hospital. Data from consecutive adult patients submitted to PN (January 2016 to December 2017; ICU and ward) were reviewed by means of an electronic database. Patient's clinical characteristics, PN prescription and catheter insertion procedure data were extracted and analyzed. The main outcome was the development of central line-associated bloodstream infection (CLABSI). The secondary outcomes were other infectious complications and mortality, as well as factors associated with CLABSI. RESULTS: We analyzed 165 patients and 247 catheters used for parenteral nutrition infusion. The CLABSI rate was 6.47 per 1000 catheter-days. In the univariable analysis, CLABSI was associated with longer hospitalization time, longer PN time, longer catheter time, catheter insertion performed by a surgeon or a surgical resident, and procedures performed outside the ICU. In an extended time-dependent Cox regression, no variable was associated with a higher risk of CLABSI, and additional PN days did not increase the rate of CLABSI. The overall mortality rate was 24.8%. Only the patients' comorbidity index was associated with death in the multivariable analysis. DISCUSSION: In our study, patients who needed PN had an overall CLABSI rate of 6.47 per 1000 catheter-days. These outcomes were not associated with PN and catheter characteristics studied after adjustment for catheter time. The overall mortality rate was 24.8% and it was not associated with PN in multivariable analyses, only with Charlson comorbidity index.
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Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Nutrição Parenteral/efeitos adversos , Adulto , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
ABSTRACT Objective: To discuss the potentialities of using the concept of vulnerability to support measures for preventing and controlling healthcare-associated infections (HAIs). Methods: This theoretical study was conducted in steps: 1) presentation of markers that frame the concept of vulnerability; 2) presentation of the characteristics of the health events to which the concept of vulnerability is intended to be applied; 3) identification of research gaps that could be potentially filled by using the concept of vulnerability; 4) identification of the potentialities of using the concept of vulnerability to deal with HAIs. Results: Proposal of a framework for analyzing HAIs from a vulnerability perspective, including the individual and collective dimensions. Conclusion: Using the concept of vulnerability to study and deal with HAIs favors a new approach to an old problem, unlike the dominant studies that highlight the individual aspects of the practices in healthcare services.
RESUMEN Objetivo: Discutir las potencialidades del uso del concepto de la vulnerabilidad para basar las acciones de prevención y control de las Infecciones Relacionadas con la Asistencia Sanitaria (IRAS). Método: Estudio de base teórica, realizado en etapas: 1) presentación de los marcadores que componen el concepto de la vulnerabilidad, 2) presentación de las características del agravio al que se pretende aplicar el concepto de la vulnerabilidad; 3) identificación de las lagunas de investigación que pueden ser potencialmente cumplimentadas por medio del uso del concepto; 4) identificación de las potencialidades del uso del concepto para el manejo de las IRAS. Resultados: Propuesta de un marco de análisis de las IRAS bajo la perspectiva de la vulnerabilidad, componiendo dimensiones individuales y colectivas. Conclusión: El uso del concepto de la vulnerabilidad en el estudio y manejo de las IRAS favorece una nueva mirada sobre un antiguo problema, diferente de los estudios hegemónicos que tratan de destacar los aspectos individuales relativos a las prácticas de atención en los servicios de salud.
RESUMO Objetivo: discutir as potencialidades do uso do conceito de vulnerabilidade para embasar as ações de prevenção e controle das Infecções Relacionadas à Assistência à Saúde (IRAS). Método: estudo de base teórica, realizado em etapas: 1) apresentação dos marcadores que compõem o conceito de vulnerabilidade; 2) apresentação das características do agravo ao qual se pretende aplicar o conceito de vulnerabilidade; 3) identificação de lacunas de pesquisa que podem ser potencialmente preenchidas por meio do uso do conceito; 4) identificação das potencialidades do uso do conceito para o manejo de IRAS. Resultados: proposta de um quadro de análise das IRAS na perspectiva da vulnerabilidade, compondo dimensões individual e coletiva. Conclusão: o uso do conceito de vulnerabilidade no estudo e manejo de IRAS favorece um novo olhar sobre um antigo problema, diferente dos estudos hegemônicos que tratam de destacar os aspectos individuais relativos às práticas de atenção nos serviços de saúde.
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Humanos , Doenças Transmissíveis/classificação , Populações Vulneráveis , Doença Iatrogênica/prevenção & controle , Brasil/epidemiologia , Doenças Transmissíveis/epidemiologia , Fatores de Risco , Direitos Humanos , Doença Iatrogênica/epidemiologiaRESUMO
ABSTRACT INTRODUCTION: Healthcare associated infections (HAIs) occur during the hospital stay as a result of underlying morbidity, invasive procedures, acute pathology or medical treatment. They lead prolonged stay and, consequently, to an increase in financial charges. The main tool to control these infections is the use of antimicrobials. However, the increase in resistance and the low frequency of discovery of new drugs justify the research that evaluates the resistance profile of microorganisms to antimicrobials. OBJECTIVE: To evaluate the prevalence and antimicrobial susceptibility profile of HAIs at a philanthropic reference hospital in Espírito Santo, Brazil. METHODS: Observational, retrospective and cross-sectional study, between July 2014 and June 2016. Data on blood, urine and corporal secretions culture were collected from the data base of the Hospital Infection Control Commission. RESULTS: There was a high prevalence of HAIs in patients older than 60 years. Two hundred and forty three (47.55%) patients were female. The four most prevalent bacteria were: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Polymyxin was the drug which presented the best antimicrobial effects. CONCLUSION: Polymyxin was active in vitro against all isolates of Acinetobacter spp. Regarding K. pneumoniae, both polymyxin and amikacin showed a significant effectiveness. Regarding Pseudomonas aeruginosa, polymyxin was effective in all samples. Regarding S. aureus, teicoplanin, daptomycin and vancomycin were effective in all samples. Polymyxin showed a good overall in vitro activity.
RESUMO INTRODUÇÃO: As infecções relacionadas com a assistência à saúde (IRAS) ocorrem durante a internação como resultado de morbidade subjacente, procedimentos invasivos, patologia aguda ou tratamento médico. Elas levam à prolongada permanência e, consequentemente, à carga econômica. A principal ferramenta para conter essas infecções são os antimicrobianos. No entanto, o aumento da resistência e a baixa taxa de descoberta de novos medicamentos justificam a pesquisa que avalia o perfil de resistência de microrganismos aos antimicrobianos. OBJETIVO: Avaliar a prevalência e o perfil de suscetibilidade antimicrobiana das IRAS ocorridas em um hospital filantrópico de referência do Espírito Santo, Brasil. MÉTODOS: Estudo observacional, retrospectivo e transversal, entre julho de 2014 e junho de 2016. Os dados sobre cultura de sangue, urina e secreções corporais foram coletados da base de dados do Centro de Controle de Infecção Hospitalar. RESULTADOS: Houve alta prevalência de IRAS em pacientes com mais de 60 anos. Duzentos e quarenta e três (47.55%) pacientes eram do sexo feminino. As quatro bactérias mais prevalentes foram: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa e Staphylococcus aureus. A polimixina foi a droga que apresentou os melhores efeitos antimicrobianos. CONCLUSÃO: A polimixina foi ativa in vitro contra todos os isolados de Acinetobacter spp. Quanto à K. pneumoniae, tanto a polimixina quanto a amicacina apresentaram eficácia significativa. Em relação à Pseudomonas aeruginosa, a polimixina foi efetiva em todas as amostras. Já em relação ao S. aureus, teicoplanina, daptomicina e vancomicina foram efetivas em todas as amostras. A polimixina demonstrou um bom desempenho geral in vitro.
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BACKGROUND: Vancomycin-resistant enterococci (VRE) are an important agent of colonization and infection in haematology patients. However, the role of virulence on VRE colonization and infection is controversial. AIM: To characterize the lineage, virulence and resistance profile of VRE infection and colonization isolates; as well as their impact on outcome of haematology patients using a regression logistic model. METHODS: Eighty-six isolates (80 Enterococcus faecium and six E. faecalis) from 76 patients were evaluated. Polymerase chain reaction for resistance and virulence genes, and pulsed-field gel electrophoresis and whole genome sequencing of the major clusters, were performed. Bivariate and multivariate analyses were carried out to evaluate the role of virulence genes on outcome. FINDINGS: All isolates harboured the vanA gene. Regarding the virulence genes, 96.5% of isolates were positive for esp, 69.8% for gelE and asa1 genes. VRE infection isolates were more virulent than colonization isolates and harboured more often the gelE gene (P = 0.008). Infections caused by VRE carrying asa1 gene resulted more frequently in death (P = 0.004), but only the predominant clone remained as protector in the multivariate model. The E. faecium strains were assigned to seven STs (ST78, ST412, ST478, ST792, ST896, ST987, ST963) that belonged to CC17. The E. faecalis sequenced belonged to ST9 (CC9). CONCLUSION: E. faecium was predominant, and infection isolates were more virulent than colonization isolates and harboured more often the gene gelE. Infections caused by VRE carrying the asa1 gene appeared to be associated with a fatal outcome.
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Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Doenças Hematológicas/complicações , Enterococos Resistentes à Vancomicina/isolamento & purificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Eletroforese em Gel de Campo Pulsado , Enterococcus faecalis/classificação , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/genética , Enterococcus faecium/classificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/genética , Feminino , Genes Bacterianos , Genótipo , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Prevalência , Estudos Retrospectivos , Análise de Sobrevida , Enterococos Resistentes à Vancomicina/classificação , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/genética , Fatores de Virulência/análise , Fatores de Virulência/genética , Sequenciamento Completo do Genoma , Adulto JovemRESUMO
ABSTRACT Introduction: Non-fermenting Gram-negative bacilli (NFGNB) are a heterogeneous group of microorganisms that do not have the ability to ferment carbohydrates as a way to obtain energy. There are more than 120 species classified as pathogenic, among them, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia and Burkholderia cepacia. Infections caused by these microorganisms are mostly acquired in the hospital environment, since they are opportunistic pathogens and are among the most important bacteria of greater clinical and epidemiological relevance. Objective: This study evaluated the resistance profile of NFGNB isolated from blood cultures at an emergency hospital in the city of Caruaru, Agreste Pernambuco (PE), Brazil. Methods: The strains present in the blood cultures were isolated on culture media MacConkey and Triple Sugar Iron (TSI) agar. The samples were also submitted to the oxidase test and the polymyxin resistance test, in addition to the Gram staining, to better identify NFGNB bacterial genera. An antibiogram test was carried out to verify the resistance profile. Results: It was found that from 87 (100%) isolated and analyzed strains, 11 (13%) were classified as NFGNB. The genus Acinetobacter sp. was the most frequently found (55%). The Acinetobacter sp. strains were resistant to gentamicin, meropenem, imipenem, amikacin, ciprofloxacin, ceftazidime and ceftriaxone. Conclusion: Screening of resistant NFGNB isolated, as well as greater attention to hospital-acquired infection control practices and epidemiological surveillance systems, in addition to continued care with regard to the targeted use of antibiotics can contribute to successful this battle against infections by these microorganisms.
RESUMO Introdução: Os bacilos Gram-negativos não fermentadores (BGNNF) são um grupo heterogêneo de microrganismos que não possuem a capacidade de fermentar carboidratos como forma de obtenção de energia. Possuem mais de 120 espécies classificadas como patogênicas, destacando-se entre elas Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia e Burkholderia cepacia. As infecções causadas por esses microrganismos são, em sua maioria, adquiridas nos ambientes hospitalares, já que se tratam de patógenos oportunistas, estando entre as bactérias de maior relevância clínica e epidemiológica. Objetivo: Este trabalho avaliou o perfil de resistência dos BGNNF isolados de hemoculturas em um hospital de emergência na cidade de Caruaru, no Agreste Pernambuco (PE), Brasil. Métodos: As cepas presentes nas hemoculturas foram isoladas nos meios de cultura ágar MacConkey e ágar Triple Sugar Iron (TSI). As amostras também foram submetidas ao teste de oxidase e ao teste de resistência a polimixina, além da coloração de Gram, para melhor identificação dos gêneros bacterianos de BGNNF. Foi realizado o antibiograma para verificação do perfil de resistência. Resultados: Verificou-se que das 87 (100%) cepas isoladas e analisadas, 11 (13%) foram classificadas como BGNNF. O gênero Acinetobacter sp. foi o mais frequente (55%). As cepas de Acinetobacter sp. apresentaram-se resistentes a gentamicina, meropenem, imipenem, amicacina, ciprofloxacina, ceftazidima e ceftriaxona. Conclusão: O rastreamento de isolados de BGNNF resistentes, bem como uma maior atenção às práticas de controle de infecção hospitalar e sistemas de vigilância epidemiológica, além do cuidado contínuo em relação ao uso direcionado de antibióticos podem contribuir no combate a infecções por esses microrganismos.
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Objetivo conhecer o impacto financeiro da infecção primária de corrente sanguínea para as organizações hospitalares. Método revisão integrativa desenvolvida nas bases de dados LILACS e EMBASE com MEDLINE, publicadas entre jun/2005 e jun/2015 com os descritores: cateteres venosos centrais, infecções relacionadas a cateter e custos e análises de custos. Resultados foram elencadas 13 publicações e houve predomínio de estudos de coorte retrospectiva, desenvolvidos na Europa ou Estados Unidos com pacientes críticos. O custo para um episódio de infecção variou de $24.090 até $34.544. Estudos europeus encontraram valores entre €16.814 e €29.909. A infecção aumentou os dias de internação entre 1,5 e 26 dias, e a mortalidade entre 1,8% e 34%. Conclusão as infecções relacionadas ao cateter representaram um custo elevado para as organizações hospitalares e, devido à discrepância entre os valores em diferentes países, há necessidade de avaliar o custo em cada realidade.
Objetivo conocer el impacto financiero de la infección primaria de corriente sanguínea para las organizaciones hospitalarias. Método revisión integradora desarrollada en las bases de datos LILACS y EMBASE con MEDLINE, publicadas entre jun/2005 y jun/2015 con los descriptores: catéteres venosos centrales, infecciones relacionadas a catéter y costos y análisis de costos. Resultados fueron listados 13 publicaciones y hubo predominio de estudios de cohorte retrospectiva, desarrollados en la Europa o Estados Unidos con pacientes críticos. El costo para un episodio de infección varió de $24.090 a $34.544. Estudios europeos encontraron valores entre €16.814 y €29.909. La infección aumentó los días de internación entre 1,5 y 26 días, y la mortalidad entre 1,8% y 34%. Conclusión las infecciones relacionadas al catéter representaron un costo elevado para las organizaciones hospitalarias y, debido a la discrepancia entre los valores en diferentes países, hay una necesidad de evaluar el costo en cada realidad.
Objective to know the financial impact of primary bloodstream infection for hospital organizations. Method integrative review carried out in the LILACS and EMBASE databases with MEDLINE, published between June 2005 and June 2015 with the descriptors: central venous catheters, catheter-related infections and costs and cost analyses. Results thirteen publications were included, and there was predominance of retrospective cohort studies conducted in Europe and the United States with critical patients. The cost for an episode of infection ranged from $ 24,090 to $ 34,544. European studies found values between €16,814 and €29,909. The infection increased the length of hospitalization between 1.5 and 26 days, and the mortality between 1.8% and 34%. Conclusion catheter-related infections incur a high cost for hospital organizations, and it is necessary to assess the cost in the case of each country because of discrepant values in different nations.
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Cateterismo Venoso Central , Infecção Hospitalar , Custos e Análise de Custo , Infecções Relacionadas a Cateter , Enfermagem Baseada em EvidênciasRESUMO
En los meses de invierno, las enfermedades respiratorias representan la primera causa de hospitalización en hospitales pediátricos. La mayoría de estas enfermedades son causadas por virus, dentro de los cuales se encuentra el adenovirus (AdV), el cual puede generar infecciones diseminadas graves, secuelantes e incluso letales y se caracteriza por tener una rápida transmisión entre pacientes, generando brotes intrahospitalarios. Se identificó a 54 pacientes hospitalizados con infección por adenovirus en el periodo de marzo-julio del 2016 con una edad promedio de 18,3 meses, de los cuales 23 casos fueron infecciones asociadas a la atención de salud (IIAS) y 2 tuvieron desenlace fatal. Los casos de IIAS, se asociaron a una mayor tasa de hospitalización prolongada (p= <0.01), ingreso a UPC (p= <0.01) y uso de ventilación mecánica (p= <0.01). No se encontró asociación entre la presencia de antecedentes mórbidos con el desarrollo de IIAS. Las IIAS por adenovirus se asocia a una hospitalización prolongada, ingreso de unidades de alta complejidad y necesidad de uso de ventilación mecánica. Dado que el adenovirus se transmite a través de contactos directo, aerosoles y fómites, las medidas básicas de precaución de contacto y de aislamiento permiten reducir los contagios nosocomiales, recayendo la responsabilidad en todo el equipo de salud a cargo.
Respiratorio deseases are frequent in winter times. being the main cause of hospital admissions. Viral infecciones are the main etiology, and adenovirus infección clould lead to severe disease, with cross infections. We identified 54 patients admitted to the Roberto del Río Childrens hospital in 2016, with a mean age of 18,3 months old; 23 cases where nosocomial infection, and 2 were fatal. Hospital acquired adenovirus infection were associated to long hospital stay (p= <0.01), intensive care admission (p= <0.01) and ventilatory support (p= <0.01). We did not find previous illness conditions. Adenovirus hospital acquired infection is associated with longer hospital stay and dead. Adenovirus is transmitted with direct contact, aerosols and fomites, therefore basic contact precautions are important.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Infecções por Adenoviridae/epidemiologia , Isolamento de Pacientes , Respiração Artificial/efeitos adversos , Estações do Ano , Fatores de Tempo , Chile/epidemiologia , Reação em Cadeia da Polimerase , Infecção Hospitalar/epidemiologia , Infecções por Adenoviridae/diagnóstico , Técnica Direta de Fluorescência para Anticorpo , HospitalizaçãoRESUMO
Abstract Objective Hand hygiene (HH) is a critical component for controlling hospital-acquired infection (HAI). The present study was designed to develop an intervention approach to improve compliance with HH among healthcare workers in a hospital setting. Methods The HH intervention study was conducted in Guizhou Provincial People's Hospital, Guiyang, China and organized by its Department of HAI Management. It was an observational, prospective, quasiexperimental (before-after intervention) study. The study was divided into two phases: the baseline phase and the intervention phase. The investigative team included clinical monitoring staff and infection control practitioners who received a series of instructions on HH compliance, monitoring skills, and measurement of the use of HH products. Results Based on 27,852 observations in a 17-month period, the rate of compliance with HH improved from 37.78% at baseline to 75.90% after intervention. Significant improvement in compliance and an increase in consumption of HH products was observed after intervention. The per patient-day consumption of alcohol-based hand rub products and handwash agents increased by 4.75 mL and 4.55 mL, respectively. The consumption of paper towels increased 3.41 sheets per patient-day. During the same period, the prevalence rate of HAI decreased 0.83%. Conclusions This study demonstrates that a significant improvement in compliance with HH can be achieved through a systemic, multidimensional intervention approach involving all categories of healthcare workers in a hospital setting, which may result in a decrease of the HAI rate.
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Humanos , Recursos Humanos em Hospital/educação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/métodos , Fatores de Tempo , Avaliação de Programas e Projetos de Saúde , China , Estudos Prospectivos , HospitaisRESUMO
OBJECTIVE: Hand hygiene (HH) is a critical component for controlling hospital-acquired infection (HAI). The present study was designed to develop an intervention approach to improve compliance with HH among healthcare workers in a hospital setting. METHODS: The HH intervention study was conducted in Guizhou Provincial People's Hospital, Guiyang, China and organized by its Department of HAI Management. It was an observational, prospective, quasiexperimental (before-after intervention) study. The study was divided into two phases: the baseline phase and the intervention phase. The investigative team included clinical monitoring staff and infection control practitioners who received a series of instructions on HH compliance, monitoring skills, and measurement of the use of HH products. RESULTS: Based on 27,852 observations in a 17-month period, the rate of compliance with HH improved from 37.78% at baseline to 75.90% after intervention. Significant improvement in compliance and an increase in consumption of HH products was observed after intervention. The per patient-day consumption of alcohol-based hand rub products and handwash agents increased by 4.75mL and 4.55mL, respectively. The consumption of paper towels increased 3.41 sheets per patient-day. During the same period, the prevalence rate of HAI decreased 0.83%. CONCLUSIONS: This study demonstrates that a significant improvement in compliance with HH can be achieved through a systemic, multidimensional intervention approach involving all categories of healthcare workers in a hospital setting, which may result in a decrease of the HAI rate.
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Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Recursos Humanos em Hospital/educação , China , Hospitais , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the safety and explore the efficacy of recombinant human lactoferrin (talactoferrin [TLf]) to reduce infection. STUDY DESIGN: We conducted a randomized, double blind, placebo-controlled trial in infants with birth weight of 750-1500 g. Infants received enteral TLf (n = 60) or placebo (n = 60) on days 1 through 28 of life; the TLf dose was 150 mg/kg every 12 hours. Primary outcomes were bacteremia, pneumonia, urinary tract infection, meningitis, and necrotizing enterocolitis (NEC). Secondary outcomes were sepsis syndrome and suspected NEC. We recorded clinical, laboratory, and radiologic findings, along with diseases and adverse events, in a database used for statistical analyses. RESULTS: Demographic data were similar in the 2 groups of infants. We attributed no enteral or organ-specific adverse events to TLf. There were 2 deaths in the TLf group (1 each due to posterior fossa hemorrhage and postdischarge sudden infant death), and 1 death in the placebo group, due to NEC. The rate of hospital-acquired infections was 50% lower in the TLf group compared with the placebo group (P < .04), including fewer blood or line infections, urinary tract infections, and pneumonia. Fourteen infants in the TLf group weighing <1 kg at birth had no gram-negative infections, compared with only 3 of 14 such infants in the placebo group. Noninfectious outcomes were not statistically significantly different between the 2 groups, and there were no between-group differences in growth or neurodevelopment over a 1-year posthospitalization period. CONCLUSION: We found no clinical or laboratory toxicity and a trend toward less infectious morbidity in the infants treated with TLf. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00854633.