RESUMO
The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.
Assuntos
Bactérias/isolamento & purificação , Biofilmes , Boca/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Traqueia/microbiologia , Ventiladores Mecânicos/microbiologia , Candida albicans/isolamento & purificação , Placa Dentária/microbiologia , Contaminação de Equipamentos , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/efeitos adversos , Estudos Longitudinais , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pneumonia Aspirativa/microbiologia , Respiração Artificial/efeitos adversos , Fatores de TempoRESUMO
Objective: To describe the microbiological characteristics and to assess the risk factors for mortality of ventilator-associated tracheobronchitis in a case-control study of intensive care patients. Methods: This case-control study was conducted over a 6-year period in a 40-bed medical-surgical intensive care unit in a tertiary care, private hospital in São Paulo, Brazil. Case patients were identified using the Nosocomial Infection Control Committee database. For the analysis of risk factors, matched control subjects were selected from the same institution at a 1:8.8 ratio, between January 2006 and December 2011. Results: A total of 40 episodes of ventilator-associated tracheobronchitis were evaluated in 40 patients in the intensive care unit, and 354 intensive care patients who did not experience tracheobronchitis were included as the Control Group. During the 6-year study period, a total of 42 organisms were identified (polymicrobial infections were 5%) and 88.2% of all the microorganisms identified were Gram-negative. Using a logistic regression model, we found the following independent risk factors for mortality in ventilator-associated tracheobronchitis patients: Acute Physiology and Chronic Health Evaluation I score (odds ratio 1.18 per unit of score; 95%CI: 1.05-1.38; p=0.01), and duration of mechanical ventilation (odds ratio 1.09 per day of mechanical ventilation; 95%CI: 1.03-1.17; p=0.004). Conclusion: Our study provided insight into the risk factors for mortality and microbiological characteristics of ventilator-associated tracheobronchitis.
Objetivo: Descrever as características microbiológicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada à ventilação mecânica em um estudo caso-controle de pacientes de terapia intensiva. Métodos: Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva médico-cirúrgica de 40 leitos, em um hospital privado e de nível terciário em São Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissão de Controle de Infecção Hospitalar. O Grupo Controle foi pareado na proporção de 1:8,8 entre janeiro de 2006 e dezembro de 2011. Resultados: Quarenta episódios de traqueobronquites associadas à ventilação foram avaliados em 40 pacientes na unidade de terapia intensiva, e 354 pacientes não apresentaram traqueobronquite Grupo Controle. Foram identificados 42 microrganismos (dos quais 5% foram infecções polimicrobianas), sendo que 88,2% de todos os microrganismos eram bactérias Gram-negativas. Usando um modelo de regressão logística, encontramos os seguintes fatores de risco independentes para mortalidade em pacientes com traqueobronquites associadas à ventilação: pontuação da Acute Physiology and Chronic Health Evaluation I (odds ratio 1,18 por uma unidade de pontuação; IC95%: 1,05-1,38; p=0,01) e duração da ventilação mecânica (odds ratio 1,09 por dia de ventilação mecânica; IC95%: 1,03-1,17; p=0,004). Conclusão: Nosso estudo forneceu informações sobre os fatores de risco para mortalidade e características microbiológicas da traqueobronquite associada à ventilação mecânica.
Assuntos
Bronquite/microbiologia , Bronquite/mortalidade , Traqueíte/microbiologia , Traqueíte/mortalidade , Ventiladores Mecânicos/efeitos adversos , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Fatores de Risco , Ventiladores Mecânicos/microbiologia , Adulto JovemRESUMO
ABSTRACT Objective To describe the microbiological characteristics and to assess the risk factors for mortality of ventilator-associated tracheobronchitis in a case-control study of intensive care patients. Methods This case-control study was conducted over a 6-year period in a 40-bed medical-surgical intensive care unit in a tertiary care, private hospital in São Paulo, Brazil. Case patients were identified using the Nosocomial Infection Control Committee database. For the analysis of risk factors, matched control subjects were selected from the same institution at a 1:8.8 ratio, between January 2006 and December 2011. Results A total of 40 episodes of ventilator-associated tracheobronchitis were evaluated in 40 patients in the intensive care unit, and 354 intensive care patients who did not experience tracheobronchitis were included as the Control Group. During the 6-year study period, a total of 42 organisms were identified (polymicrobial infections were 5%) and 88.2% of all the microorganisms identified were Gram-negative. Using a logistic regression model, we found the following independent risk factors for mortality in ventilator-associated tracheobronchitis patients: Acute Physiology and Chronic Health Evaluation I score (odds ratio 1.18 per unit of score; 95%CI: 1.05-1.38; p=0.01), and duration of mechanical ventilation (odds ratio 1.09 per day of mechanical ventilation; 95%CI: 1.03-1.17; p=0.004). Conclusion Our study provided insight into the risk factors for mortality and microbiological characteristics of ventilator-associated tracheobronchitis.
RESUMO Objetivo Descrever as características microbiológicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada à ventilação mecânica em um estudo caso-controle de pacientes de terapia intensiva. Métodos Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva médico-cirúrgica de 40 leitos, em um hospital privado e de nível terciário em São Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissão de Controle de Infecção Hospitalar. O Grupo Controle foi pareado na proporção de 1:8,8 entre janeiro de 2006 e dezembro de 2011. Resultados Quarenta episódios de traqueobronquites associadas à ventilação foram avaliados em 40 pacientes na unidade de terapia intensiva, e 354 pacientes não apresentaram traqueobronquite Grupo Controle. Foram identificados 42 microrganismos (dos quais 5% foram infecções polimicrobianas), sendo que 88,2% de todos os microrganismos eram bactérias Gram-negativas. Usando um modelo de regressão logística, encontramos os seguintes fatores de risco independentes para mortalidade em pacientes com traqueobronquites associadas à ventilação: pontuação da Acute Physiology and Chronic Health Evaluation I (odds ratio 1,18 por uma unidade de pontuação; IC95%: 1,05-1,38; p=0,01) e duração da ventilação mecânica (odds ratio 1,09 por dia de ventilação mecânica; IC95%: 1,03-1,17; p=0,004). Conclusão Nosso estudo forneceu informações sobre os fatores de risco para mortalidade e características microbiológicas da traqueobronquite associada à ventilação mecânica.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Traqueíte/microbiologia , Traqueíte/mortalidade , Bronquite/microbiologia , Bronquite/mortalidade , Ventiladores Mecânicos/efeitos adversos , Brasil/epidemiologia , Ventiladores Mecânicos/microbiologia , Modelos Logísticos , Análise Multivariada , Fatores de Risco , Mortalidade Hospitalar , Medição de Risco , APACHE , Bactérias Gram-Negativas/isolamento & purificação , Unidades de Terapia Intensiva , Pessoa de Meia-IdadeRESUMO
Abstract The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Bactérias/isolamento & purificação , Biofilmes , Boca/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Traqueia/microbiologia , Ventiladores Mecânicos/microbiologia , Candida albicans/isolamento & purificação , Placa Dentária/microbiologia , Contaminação de Equipamentos , Unidades de Terapia Intensiva , Intubação Intratraqueal/efeitos adversos , Estudos Longitudinais , Testes de Sensibilidade Microbiana , Pneumonia Aspirativa/microbiologia , Respiração Artificial/efeitos adversos , Fatores de TempoRESUMO
Abstract Aims The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU). Methods This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0–2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data. Results In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR = 2.60, 95% CI: 1.04–6.49, p = 0.0279). The mean ± SD MCPIS was calculated as 3.91 ± 1.35 in the HP group and 4.65 ± 1.55 in the NS group, a difference statistically significant (p = 0.042). There were no significant differences in the risk factors for VAP between the two groups. Conclusion HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Peróxido de Hidrogênio/uso terapêutico , Unidades de Terapia Intensiva , Anti-Infecciosos Locais/uso terapêutico , Antissépticos Bucais/uso terapêutico , Ventiladores Mecânicos/microbiologia , Incidência , Inquéritos e Questionários , Reprodutibilidade dos Testes , Fatores de Risco , Resultado do Tratamento , Estatísticas não ParamétricasRESUMO
AIMS: The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU). METHODS: This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0-2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data. RESULTS: In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR=2.60, 95% CI: 1.04-6.49, p=0.0279). The mean±SD MCPIS was calculated as 3.91±1.35 in the HP group and 4.65±1.55 in the NS group, a difference statistically significant (p=0.042). There were no significant differences in the risk factors for VAP between the two groups. CONCLUSION: HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP.
Assuntos
Anti-Infecciosos Locais/uso terapêutico , Peróxido de Hidrogênio/uso terapêutico , Unidades de Terapia Intensiva , Antissépticos Bucais/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores de Risco , Estatísticas não Paramétricas , Inquéritos e Questionários , Resultado do Tratamento , Ventiladores Mecânicos/microbiologiaRESUMO
OBJECTIVE: To analyze biofilm on internal and external surfaces of endotracheal tubes after their use in critical care patients, and to produce evidence of association between use of the tube, presence of biofilm, and the occurrence of pneumonia. METHODS: This was a clinical study performed at the Intensive Care Unit of an emergency hospital in the interior of São Paulo state, Brazil. Data collection involved 30 endotracheal tubes used on adult patients for a period of ≥48 h of mechanical ventilation for scanning electron microscopy. RESULTS: Analysis of the biofilm on the 30 tubes by scanning electron microscopy showed various abiotic and biotic structures, predominantly on the internal surface, such as: fibrin network, erythrocytes, leukocytes, cocci, bacilli, and molds, among others. The intubation period of the endotracheal tube for ≥8 days represented one of the risk factors for ventilator-associated pneumonia (RR 7.41, P < 0.001). CONCLUSIONS: The presence of the endotracheal tube permits microbial colonization, overall contributing to the development of biofilm and the occurrence of pneumonia.
Assuntos
Biofilmes , Contaminação de Equipamentos , Intubação Intratraqueal/efeitos adversos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Ventiladores Mecânicos/microbiologia , Bactérias/isolamento & purificação , Bactérias/ultraestrutura , Fenômenos Fisiológicos Bacterianos , Brasil , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/instrumentação , Pneumonia Associada à Ventilação Mecânica/etiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Respiração Artificial/efeitos adversosRESUMO
PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs). METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria. RESULTS: Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level. CONCLUSIONS: Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.
Assuntos
Infecções Relacionadas a Cateter/mortalidade , Infecção Hospitalar/epidemiologia , Países em Desenvolvimento , Unidades de Terapia Intensiva Neonatal , Pneumonia Associada à Ventilação Mecânica/mortalidade , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/mortalidade , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Contaminação de Equipamentos , Hospitais Privados/classificação , Hospitais Públicos/classificação , Hospitais de Ensino/classificação , Humanos , Recém-Nascido , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Prospectivos , Fatores Socioeconômicos , Ventiladores Mecânicos/efeitos adversos , Ventiladores Mecânicos/microbiologiaRESUMO
Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insufficiency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and sufficient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5%.
Assuntos
Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Ventiladores Mecânicos/microbiologia , Desinfecção/normas , Serviços de Assistência Domiciliar , Humanos , Higiene/normas , Pneumopatias Obstrutivas/terapia , Respiração Artificial/instrumentaçãoRESUMO
Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientific evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insufficiency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and sufficient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5 percent.
Assuntos
Humanos , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Ventiladores Mecânicos/microbiologia , Desinfecção/normas , Serviços de Assistência Domiciliar , Higiene/normas , Pneumopatias Obstrutivas/terapia , Respiração Artificial/instrumentaçãoRESUMO
NEED: The rates of health care-associated infections (HAIs) and bacterial resistance in developing countries are 3 to 5 times higher than international standards. HAIs increase length of stay (10 days), costs (US $5000 to US $12,000), and mortality (by a factor of 2 to 3). ORGANIZATION: The International Nosocomial Infection Control Consortium (INICC), founded in 1998, is the only source of aggregated international data on the epidemiology of device-associated infections (DAIs). Its advisory board includes 12 representatives from developed countries, who help guide INICC's activities, and 8 country coordinators. The INICC network has about 5400 active researchers in 98 intensive care units (ICUs) in 18 countries on 4 continents that conduct infection control research and surveillance using standardized DAI surveillance definitions and methodologies. SURVEILLANCE: Participating hospitals use the Centers for Disease Control and Prevention (CDC) surveillance method and DAI definitions. Unlike the CDC, the INICC collects data from patients with and without DAI and matches patients to evaluate risk factors, attributable mortality, length of stay, and costs and conducts process surveillance to measure and improve compliance with infection control guidelines. RESULTS: INICC's surveillance at 98 ICUs in 18 limited resources countries on 4 continents for 10 years has significantly improved infection control guidelines compliance and reduced DAI rates and mortality rates. After 11 years of implementing process surveillance intervention in 77 ICUs of 34 cities of 14 countries, including observation of 88,661 opportunities for hand hygiene, education, performance monitoring, feedback, and peer support from high-level hospital administrators, hand-hygiene compliance among ICU healthcare workers increased from 35.1% to 60.7% (RR 1.73, P < 0.01). In 78 ICUs of 37 cities of 13 countries, by implementing outcome and process surveillance interventions, INICC reduced central line associated bloodstream infection (CLAB) rates from 16.1 to 10.1 CLABs per 1000 CL days (RR: 0.63, P < 0.01), ventilator associated pneumonia (VAP) from 22.5 to 18.6 VAPs per1000 device days (RR: 0.83, P < 0.01), and catheter associated urinary tract infections (CAUTI) rates from 8.2 to 6.9 CAUTIs per 1000 device days (RR: 0.85, P = 0.02). CONCLUSION: Implementation of INICC outcome and process surveillance, education, monitoring and performance feedback methodologies increases compliance with hand hygiene and other infection-control interventions and reduces rates of DAIs.
Assuntos
Infecção Hospitalar/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Contaminação de Equipamentos/estatística & dados numéricos , Recursos em Saúde/economia , Controle de Infecções/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres de Demora/microbiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana , Fidelidade a Diretrizes , Humanos , Unidades de Terapia Intensiva/normas , Tempo de Internação , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Fatores de Risco , Vigilância de Evento Sentinela , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controle , Ventiladores Mecânicos/efeitos adversos , Ventiladores Mecânicos/microbiologiaRESUMO
OBJECTIVE: The present study was aimed at determining device-associated infection rates, device use rates and the microbiologic profile of nosocomial infections in a tertiary neonatal intensive care unit (ICU) in Bogotá, Colombia. METHODS: Prospective nosocomial infection surveillance was implemented in a neonatal intensive care unit for 11 months in line with the High Risk Nursery component of the Colombian Nosocomial Infection Surveillance programme. Patient-days, length of stay, device use rates and device-associated nosocomial infection rates were calculated. RESULTS: 1 998 device days were observed among 2 890 patient days during the 11 months' surveillance. Central venous catheter-related bloodstream infection was the most common device-associated infection for all birth-weight categories. 69,2 % and 100 % of all coagulase negative staphylococci and Staphylococcus aureus infections were methicillin resistant strains and all gram negative rods were susceptible to third generation cephalosporins, carbapenems, ciprofloxacin and piperacillin-tazobactam. Device-associated infection and device use rates in the ICU were higher than Colombian Nosocomial Infection Surveillance reports for October 2004 and reports from Colombia and other Latin-American countries. CONCLUSIONS: This surveillance identified blood-stream infection as being the most common infection in the ICU in question. Efforts should thus be directed at establishing suitable infection-control practices.
Assuntos
Bacteriemia/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Equipamentos e Provisões/efeitos adversos , Equipamentos e Provisões/microbiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Área Programática de Saúde , Colômbia/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Estudos Prospectivos , Ventiladores Mecânicos/microbiologiaRESUMO
Objective: The present study was aimed at determining device-associated infection rates, device use rates and the microbiologic profile of nosocomial infections in a tertiary neonatal intensive care unit (ICU) in Bogotá, Colombia. Methods: Prospective nosocomial infection surveillance was implemented in a neonatal intensive care unit for 11 months in line with the High Risk Nursery component of the Colombian Nosocomial Infection Surveillance programme. Patient-days, length of stay, device use rates and device-associated nosocomial infection rates were calculated. Results: 1 998 device days were observed among 2 890 patient days during the 11 months' surveillance. Central venous catheter-related bloodstream infection was the most common device-associated infection for all birth-weight categories. 69,2 percent and 100 percent of all coagulase negative staphylococci and Staphylococcus aureus infections were methicillin resistant strains and all gram negative rods were susceptible to third generation cephalosporins, carbapenems, ciprofloxacin and piperacillin-tazobactam. Device-associated infection and device use rates in the ICU were higher than Colombian Nosocomial Infection Surveillance reports for October 2004 and reports from Colombia and other Latin-American countries. Conclusions: This surveillance identified blood-stream infection as being the most common infection in the ICU in question. Efforts should thus be directed at establishing suitable infection-control practices.
Objetivo: El objetivo del presente estudio fue determinar las tasas de infección asociadas a dispositivos médicos, las tasas de utilización y el perfil microbiológico de las infecciones hospitalarias en una unidad de terapia intensiva neonatal en Bogotá-Colombia. Métodos: Un sistema de vigilancia de infección hospitalaria fue implementado en la unidad de terapia intensiva neonatal de un hospital de tercer nivel durante un periodo de 11 meses de acuerdo al componente neonatal del sistema de vigilancia de infección hospitalaria de los estados unidos. Se calcularon los días pacientes, los días de estancia, las tasas de utilización y de infección asociadas a dispositivos invasivos. Resultados: Un total de 1 998 días dispositivos fueron observados entre 2 890 días paciente durante los 11 meses de vigilancia. La infección asociada a catéter central fue la infección más frecuente entre las diferentes categorías de peso neonatal. El 69,2 por ciento y el 100 por ciento de todos los Staphylococos coagulasa negativa y Staphylococcus aureus fueron resistentes a meticilina respectivamente, y todos los bacilos gram negativos fueron susceptibles a las Cefalosporinas de tercera generación, Carbapenemicos, Ciprofloxacina y a Piperacilina-Tazobactam. Las tasas de infección asociada a dispositivos invasivos y las tasas de utilización en nuestra unidad fueron superiores al reporte de octubre del 2004 del sistema de vigilancia de infección hospitalaria de los estados unidos y de otros trabajos realizados en Colombia y en Latinoamérica. Conclusiones: Este proceso de vigilancia ha permitido identificar que las infecciones del torrente sanguíneo comprende el principal problema de nuestra unidad y por tal motivo la necesidad de implementar adecuadas medidas de control de infecciones para disminuir la ocurrencia de esta infección debe ser la prioridad de nuestra institución.
Assuntos
Feminino , Humanos , Masculino , Bacteriemia/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Equipamentos e Provisões/efeitos adversos , Equipamentos e Provisões/microbiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Área Programática de Saúde , Colômbia/epidemiologia , Unidades de Terapia Intensiva/normas , Estudos Prospectivos , Ventiladores Mecânicos/microbiologiaRESUMO
BACKGROUND: Vancomycin-resistant enterococci (VRE) is an important pathogen in the hospital environment, and a progressive increase in its incidence is a cause of nosocomial infections. Bacteremia is one of the major infections caused by this pathogen. Risk factors for VRE bacteremia were assessed at a university-affiliated hospital. METHODS: Two case-control studies with different control groups were used. In study 1, patients with VRE bacteremia were compared with control patients matched by sex, admission unit, age (+/-10 years), and time of admission (+/-1 year). In study 2, the case group (VRE patients) was compared with vancomycin-susceptible enterococci (VSE) patients. RESULTS: A total of 34 patients with VRE bacteremia and 102 control patients were included in study 1, and 34 patients with VRE bacteremia and 55 patients with VSE bacteremia were included in study 2. In study 1, vancomycin use (OR, 10.19; CI 95%, 3.63-28.57) was associated with VRE bacteremia. In study 2, vancomycin use (OR, 17.58; CI 95%, 5.24-58.96) was also associated with VRE bacteremia. CONCLUSION: Because vancomycin use was the only variable associated with VRE bacteremia in the two studies, we confirmed that vancomycin exposure is the major risk factor for VRE bacteremia.
Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Enterococcus faecalis/efeitos dos fármacos , Resistência a Vancomicina , Brasil , Estudos de Casos e Controles , Cateteres de Demora/microbiologia , Humanos , Tempo de Internação , Modelos Logísticos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ventiladores Mecânicos/microbiologiaRESUMO
INTRODUCTION: This study sought to assess the prognostic value of the kinetics of procalcitonin (PCT), C-reactive protein (CRP) and clinical scores (clinical pulmonary infection score (CPIS), Sequential Organ Failure Assessment (SOFA)) in the outcome of ventilator-associated pneumonia (VAP) at an early time point, when adequacy of antimicrobial treatment is evaluated. METHODS: This prospective observational cohort study was conducted in a teaching hospital. The subjects were 75 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before the 28th day were non-survivors. There were no interventions. RESULTS: PCT, CRP and SOFA score were determined on day 0 and day 4. Variables included in the univariable logistic regression model for survival were age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, decreasing DeltaSOFA, decreasing DeltaPCT and decreasing DeltaCRP. Survival was directly related to decreasing DeltaPCT with odds ratio (OR) = 5.67 (95% confidence interval 1.78 to 18.03), decreasing DeltaCRP with OR = 3.78 (1.24 to 11.50), decreasing DeltaSOFA with OR = 3.08 (1.02 to 9.26) and APACHE II score with OR = 0.92 (0.86 to 0.99). In a multivariable logistic regression model for survival, only decreasing DeltaPCT with OR = 4.43 (1.08 to 18.18) and decreasing DeltaCRP with OR = 7.40 (1.58 to 34.73) remained significant. Decreasing DeltaCPIS was not related to survival (p = 0.59). There was a trend to correlate adequacy to survival. Fifty percent of the 20 patients treated with inadequate antibiotics and 65.5% of the 55 patients on adequate antibiotics survived (p = 0.29). CONCLUSION: Measurement of PCT and CRP at onset and on the fourth day of treatment can predict survival of VAP patients. A decrease in either one of these marker values predicts survival.
Assuntos
Proteína C-Reativa/antagonistas & inibidores , Calcitonina/antagonistas & inibidores , Pneumonia Bacteriana/sangue , Pneumonia Bacteriana/mortalidade , Precursores de Proteínas/antagonistas & inibidores , Ventiladores Mecânicos/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/biossíntese , Calcitonina/biossíntese , Calcitonina/sangue , Peptídeo Relacionado com Gene de Calcitonina , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Precursores de Proteínas/biossíntese , Precursores de Proteínas/sangue , Respiração Artificial/mortalidade , Taxa de SobrevidaRESUMO
OBJECTIVE: To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium. METHODS: We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days. RESULTS: During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)-related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P=.002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P=.19). CONCLUSION: The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.
Assuntos
Infecção Hospitalar/epidemiologia , Equipamentos e Provisões/efeitos adversos , Unidades de Terapia Intensiva/estatística & dados numéricos , Vigilância de Evento Sentinela , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Colômbia/epidemiologia , Infecção Hospitalar/classificação , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Equipamentos e Provisões/microbiologia , Mortalidade Hospitalar , Humanos , Incidência , Unidades de Terapia Intensiva/normas , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etiologia , Medição de Risco , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Ventiladores Mecânicos/microbiologiaRESUMO
Lavado de manos. - Uso preferencial TET vs. nasotraqueal. - Uso VNI. - Cambio no rutinario de circuitos. - Uso no recomendado de antiácidos. - Uso racional de ATB.
Assuntos
Humanos , Recém-Nascido , Pneumonia/etiologia , Pneumonia/microbiologia , Pneumonia/prevenção & controle , Respiração Artificial/efeitos adversos , Fatores de Risco , Ventiladores Mecânicos/microbiologia , Ventiladores Mecânicos/normasRESUMO
BACKGROUND: Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU) setting. No previous data are available on the incidence of device-associated nosocomial infections in different types of ICUs in Argentina. METHODS: We performed a prospective nosocomial infection surveillance study during the first year of an infection control program in six Argentinean ICUs. Nosocomial infections were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System definitions, and site-specific nosocomial infection rates were calculated. RESULTS: The rate of catheter-associated bloodstream infections in medical-surgical ICUs was 30.3 per 1,000 device-days; it was 14.2 per 1,000 device-days in coronary care units (CCUs). The rate of ventilator-associated pneumonia in medical-surgical ICUs was 46.3 per 1,000 device-days; it was 45.5 per 1,000 device-days in CCUs. The rate of symptomatic catheter-associated urinary tract infections in medical-surgical ICUs was 18.5 per 1,000 device-days; it was 12.1 per 1,000 device-days in CCUs. CONCLUSION: The high rate of nosocomial infections in Argentinean ICUs found during our surveillance suggests that ongoing targeted surveillance and implementation of proven infection control strategies is needed in developing countries such as Argentina.
Assuntos
Infecção Hospitalar/epidemiologia , Contaminação de Equipamentos , Unidades de Terapia Intensiva , Vigilância de Evento Sentinela , Argentina/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/microbiologia , Países em Desenvolvimento , Humanos , Controle de Infecções/normas , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Ventiladores Mecânicos/microbiologiaRESUMO
BACKGROUND: Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU). Limited data exists on the incidence and burden of nosocomial infection in the ICU in Argentina. METHODS: We performed baseline prospective nosocomial infection surveillance of all patients for 6 months in 3 medical-surgical ICUs (MS-ICUs) in Argentina (2 months in each ICU). Nosocomial infections were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance definitions. Overall and site-specific nosocomial infection rates, attributable mortality, and excess length of hospital stay were calculated. RESULTS: The overall nosocomial infection rate was 27% and 90 per 1000 patient-days. The most common site of infection was catheter-related bloodstream infection (32%), followed by ventilator-associated pneumonia (25%), and catheter-associated urinary tract infection (23%). The rate of central catheter-associated bloodstream infection in the MS-ICU was 44.61 per 1000 device-days, with an attributable mortality of 25%, and 12 attributable extra days of hospital stay. The urinary catheter-associated urinary tract infection rate in the MS-ICU was 22.55 per 1000 urinary catheter-days, with an attributable mortality of 5%, and 5 excess extra days of hospital stay. The ventilator-associated pneumonia rate in the MS-ICU was 50.87 per 1000 ventilator-days with an attributable mortality of 35%, and 10 attributable extra days of hospitalization. CONCLUSION: Our study finds high rates of nosocomial infections in ICUs in Argentina, associated with a considerable attributable mortality and excess length of stay. Ongoing targeted surveillance and implementation of infection control strategies is necessary to control this growing problem.