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1.
West Indian med. j ; 51(1): 21-4, Mar. 2002. tab
Artigo em Inglês | MedCarib | ID: med-102

RESUMO

The nosocomial infection rate in an Intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 percent compared to the overall nosocomial infection rate of 15.3 percent for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5 percent), followed by surgical wounds, 35 (25.2 percent), urinary tract, 28 (20.1 percent) and the blood stream, 24 (17.3 percent). From 165 bacterial isolates, 80 percent of isolates were gram-negative rods, with P aeruginosa, 48 (36.6 percent), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6 percent), and Enterobacter sp, 22 (16.8 percent). The main gram-positive isolates were S aureus, 23 (41.8 percent), coagulase-negative Staphylococci, 17 (30.9 percent), and Enterococci, 11 (20.0 percent). Of the 23 S aureus strains, 15 (65.2 percent) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8 percent) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 percent and 55.4 percent, respectively. Gentamicin, azteronam, piperacillin-tazobactam showed resistance rates of less than 15 percent. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution. (AU)


Assuntos
Humanos , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Trinidad e Tobago/epidemiologia , Coleta de Dados , Infecções Respiratórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Bacilos e Cocos Aeróbios Gram-Negativos/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Enterobacter/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Gentamicinas/uso terapêutico , Aztreonam/uso terapêutico , Piperacilina/uso terapêutico
2.
Artigo em Inglês | MedCarib | ID: med-17769

RESUMO

Antimicrobial susceptibility patterns of strains of Escherichia coli isolated between 1994 and 1998 were studied. Of the 1,283 strains examined, 75% were recovered from urine, 8.7% from wounds, 3.2% from blood, 2.6% from pus, and 10.5% from other sources. Isolates from inpatients and outpatients accounted for 46.1% and 53.9%, respectively. Gentamicin and nalidixic acid showed the greatest efficacy against isolates from both inpatients and outpatients, revealing a >90% sensitivity. Drugs with the lowest efficacies were ampicillin and amoxicillin-clavulanic acid, which showed a >45% resistance. Tetracycline showed a significant decline in resistance from 1994 to 1998 among strains from both inpatients and outpatients (P < 0.001). This decline may be related to a policy of restrictive antibiotic reporting by the Microbiology Laboratory and seminars for general practitioners, subsequent to an island-wide survey an antibiotic resistance. A similar pattern of declining resistance was also observed for cefuroxime. E. coli sensitivity to co-trimoxazole was relatively stable during the study period. Although the overall prevalence of resistance among E. coli strains is relatively low, on-going surveillance of bacterial resistance must continue. The microbial antibiogram can provide general practitioners and clinicians with data essential for optimum empiric choices. Further, the introduction of a policy of restrictive reporting may act "synergistically" with the education of doctors on resistance patterns, to effect island-wide reduction of antimicrobial resistance.


Assuntos
Humanos , Estudo Comparativo , Combinação Amoxicilina e Clavulanato de Potássio/farmacologia , Ampicilina/farmacologia , Antibacterianos/farmacologia , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Cefuroxima/farmacologia , Cefalosporinas/farmacologia , Resistência Microbiana a Medicamentos , Gentamicinas/farmacologia , Hospitais Privados , Testes de Sensibilidade Microbiana , Ácido Nalidíxico/farmacologia , Penicilinas/farmacologia , Tetraciclina/farmacologia , Trinidad e Tobago
3.
World Health Forum ; 18(1): 49-52, 1997.
Artigo em Inglês | MedCarib | ID: med-1958

RESUMO

Health service provided by public or private institutions at the primary and hospital referral levels should be coordinated so that the available resources are distributed equitably to meet the needs and aspirations of the population. The challenge is to improve the quality of hospital care and the existing pattern of public and private services in Latin America and the Caribbean.(AU)


Assuntos
Humanos , Hospitais Públicos/organização & administração , Hospitais Privados/organização & administração , Administração Hospitalar , Administração Financeira , Custos de Cuidados de Saúde , América Latina , Transferência de Tecnologia , Índias Ocidentais
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