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This is a case of a kidney transplant recipient who presented with skin lesions, low-grade fevers, and pancytopenia 2 months after his transplant.
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Trasplante de Riñón , Humanos , Argentina , Trasplante de Riñón/efectos adversos , América LatinaRESUMEN
BACKGROUND: Performance of active screening for multidrug-resistant Gram-negative bacteria (MDR-GNB) and administration of targeted antibiotic prophylaxis (TAP) in colonized patients undergoing liver (LT) and/or kidney transplantation (KT) are controversial issues. METHODS: Self-administered electronic cross-sectional survey disseminated from January to February 2022. Questionnaire consisted of four parts: hospital/transplant program characteristics, standard screening and antibiotic prophylaxis, clinical vignettes asking for TAP in patients undergoing LT and KT with prior infection/colonization with four different MDR-GNB (extended-spectrum cephalosporin-resistant Enterobacterales [ESCR-E], carbapenem-resistant Enterobacterales [CRE], multidrug-resistant Pseudomonas aeruginosa [MDR-Pa], and carbapenem-resistant Acinetobacter baumannii [CRAb]). RESULTS: Fifty-five respondents participated from 14 countries, mostly infectious disease specialists (69%) with active transplant programs (>100 procedures/year for 34.5% KT and 23.6% LT), and heterogeneous local MDR-GNB prevalence from <15% (30.9%), 15%-30% (43.6%) to >30% (16.4%). The frequency of screening for ESCR-E, CRE, MDR-Pa, and CRAb was 22%, 54%, 17%, and 24% for LT, respectively, and 18%, 36%, 16%, and 11% for KT. Screening time-points were mainly at transplantation 100%, only one-third following transplantation. Screening was always based on rectal swab cultures (100%); multi-site sampling was reported in 40% of KT and 35% of LT. In LT clinical cases, 84%, 58%, 84%, and 40% of respondents reported TAP for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. In KT clinical cases, 55%, 39%, 87%, and 42% of respondents reported TAP use for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. CONCLUSION: There is a large heterogeneity in screening and management of MDR-GNB carriage in LT and KT.
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Infecciones por Bacterias Gramnegativas , Trasplante de Riñón , Humanos , Profilaxis Antibiótica , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/prevención & control , Trasplante de Riñón/efectos adversos , Estudios Transversales , Bacterias Gramnegativas , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple , Hígado , Carbapenémicos , Encuestas y CuestionariosRESUMEN
Introduction: Accidents with biological material and cuting/piercing instruments among health professionals have led to increased rates of hospital infection and subsequent patient contamination. Objectives: To compare factors associated with accidents involving biological material among health workers. Methods: This cross-sectional epidemiological study, conducted in 2019-2020, included 229 physicians and non-physicians. Results: The sample was 60.7% physicians and 39.3% non-physicians; 51.5% were women; 48.5% were aged ≥40 years; 55% lived with a partner; 57.6% had a specialist or graduate degree; and 51.5% had ≥ 1 child). he physician group had a higher education level, worked > 1 job, and had a high rate of accidents, in addition to lower rates of pre-employment examinations, specific accident training, and supervisor contact in case of accidents. There was also a positive association in the physician group between accidents, employment length, and operating room experience, while age was inversely correlated with accident risk. Conclusions: Different worker categories had specific risk profiles that involved education level, employment length, a low notification level, and risk underestimation. The results showed that education level and employment length do not guarantee accidents prevention. Both the physician and non-physician groups had significant accident rates and a similar behavior profile when events occurred, including low notification rates and underestimating the risk involved in the accident.
Introdução: Acidentes envolvendo material biológico com instrumentos cortantes e perfurantes entre profissionais de saúde têm sido causa de aumento de infecção hospitalar e, portanto, de contaminação do paciente. Objetivos: Comparar fatores associados ao acidente com material biológico em trabalhadores da saúde. Métodos: Estudo epidemiológico transversal envolvendo 229 profissionais, médicos e não médicos (2019-2020). Resultados: A amostra total foi composta por 229 profissionais (48,1% médicos, 51,9% não médicos, 51,5% mulheres, 48,5% ≥ 40 anos, 55% viviam com companheiro, 57,6% tinham nível educacional de especialização/pós-graduação, 51,5% ≥ um filho). Os profissionais médicos apresentaram maior escolaridade, mais de um emprego e maior proporção de ocorrência de acidentes, bem como menor proporção de exames admissionais, treinamentos específicos e contato com supervisor em casos de acidentes. Ainda, os profissionais médicos apresentaram associação positiva dos acidentes com o tempo de trabalho e o tempo de experiência no bloco cirúrgico, enquanto a idade apresentou relação inversa com as chances de acidentes. Conclusões: Diferentes categorias de trabalho apresentaram perfil específico de riscos envolvendo estudo e tempo de serviço, baixa notificação e risco subestimado. Os resultados deste estudo mostraram que o nível de estudo e o tempo de serviço não foram capazes de garantir a prevenção de acidentes envolvendo material biológico. Além disso, profissionais médicos e não médicos apresentaram não apenas uma incidência significativa de acidentes, mas também um perfil de comportamento semelhante diante do evento, com baixa notificação e risco subestimado do acidente.
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Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.
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Humanos , Masculino , Adulto , Fiebre Amarilla/complicaciones , Hepatitis/complicaciones , Recurrencia , Hepatitis/inmunologíaRESUMEN
Abstract Objective: The aim of this study was to compare two different empiric treatments for late-onset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase-negative Staphylococcus. Methods: A cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at-risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program. Results: There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram-negative bacterial or fungal infections. An increase in coagulase-negative Staphylococcus infections was observed (p = 0.022). However, there was no measured increase in related morbidity and mortality. There was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p < 0.001) and an increase of one day in the median number of days of treatment with vancomycin (p = 0.046). Conclusions: Modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in S. aureus infections, as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. As a result, oxacillin can be considered as an effective treatment for late-onset sepsis, making it possible to avoid broad-spectrum antibiotics.
Resumo Objetivo Comparar dois períodos com diferentes esquemas empíricos para tratamento de sepse neonatal tardia, incluindo vancomicina ou oxacilina respectivamente, em unidade neonatal de referência com alta prevalência de Staphylococcus coagulase negativo. Métodos Estudo transversal, feito em unidade neonatal de referência, de 2011 a 2014. Os dados foram coletados diariamente por vigilância ativa em prontuário de recém-nascidos de risco. As infecções foram notificadas conforme critérios definidos pela Agência Nacional de Vigilância Sanitária. O banco de dados e a análise foram feitos em programa interno. Resultados Ocorreu redução significativa da notificação de infecções por Staphylococcus aureus (p = 0,008), sem notificações de endocardite, meningite e infecções de vias aéreas inferiores, além de redução na frequência de óbitos pelo microrganismo e sem alteração significativa nas incidências de infecções por bactérias Gram negativas e fungos. Houve aumento de infecções S. aureus coagulase negativo (p = 0,022), mas sem aumento de morbidade e mortalidade. Ocorreu redução na mediana do tempo de uso de oxacilina, de 11,5 para 6 dias (p < 0,001), com aumento de mediana de um dia de uso de vancomicina (p = 0,046). Conclusões A modificação do esquema empírico com uso de oxacilina revelou redução significativa das infecções por S. aureus, além da redução na frequência de infecção de foco profundo e mortalidade pelo microrganismo. Considera-se que oxacilina pode ser usada como esquema de tratamento de sepse neonatal tardia para se evitar o uso de antibióticos de largo espectro.
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Humanos , Masculino , Femenino , Recién Nacido , Oxacilina/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/uso terapéutico , Sepsis Neonatal/tratamiento farmacológico , Antibacterianos/uso terapéutico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Staphylococcus , Staphylococcus aureus , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Estudios Transversales , Estudios Prospectivos , Resultado del Tratamiento , Sepsis Neonatal/microbiología , Sepsis Neonatal/mortalidadRESUMEN
Abstract Coagulase-negative Staphylococcus has been identified as the main nosocomial agent of neonatal late-onset sepsis. However, based on the pharmacokinetics and erratic distribution of vancomycin, recommended empirical dose is not ideal, due to the inappropriate serum levels that have been measured in neonates. The aim of this study was to evaluate serum levels of vancomycin used in newborns and compare the prediction of adequate serum levels based on doses calculated according to mg/kg/day and m2/day. This is an observational reprospective cohort at a referral neonatal unit, from 2011 to 2013. Newborns treated with vancomycin for the first episode of late-onset sepsis were included. Total dose in mg/kg/day, dose/m2/day, age, weight, body surface and gestational age were identified as independent variables. For predictive analysis of adequate serum levels, multiple linear regressions were performed. The Receiver Operating Characteristic curve for proper serum vancomycin levels was also obtained. A total of 98 patients received 169 serum dosages of the drug, 41 (24.3%) of the doses had serum levels that were defined as appropriate. Doses prescribed in mg/kg/day and dose/m2/day predicted serum levels in only 9% and 4% of cases, respectively. Statistical significance was observed with higher doses when the serum levels were considered as appropriate (p < 0.001). A dose of 27 mg/kg/day had a sensitivity of 82.9% to achieve correct serum levels of vancomycin. Although vancomycin has erratic serum levels and empirical doses cannot properly predict the target levels, highest doses in mg/kg/day were associated with adequate serum levels.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Vancomicina/administración & dosificación , Vancomicina/sangre , Sepsis Neonatal/tratamiento farmacológico , Antibacterianos/administración & dosificación , Antibacterianos/sangre , Valores de Referencia , Staphylococcus/efectos de los fármacos , Esquema de Medicación , Modelos Lineales , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Edad Gestacional , Estadísticas no Paramétricas , Relación Dosis-Respuesta a Droga , Sepsis Neonatal/sangreRESUMEN
Objetivos: descrever a evolução dos pacientes com diagnóstico de hepatite viral B ou C submetidos a transplante de fígado em serviço de referência. Métodos: trata-se de estudo transversal realizado no Serviço de Transplante de Órgãos do Instituto Alfa de Gastroenterologiado Hospital das Clínicas da Universidade Federal de Minas Gerais, de 2005 a 2007. Os dados foram coletados em prontuários médicos e bancos de dados do serviço.Resultados: de 173 pacientes submetidos a transplante de fígado, 61 apresentavam hepatite C, nove tinham hepatite B e um evoluiu com hepatite A fulminante. Entre os pacientes com hepatite C, 31 receberam tratamento antes do transplante (sete com respostavirológica sustentada). Apenas dois pacientes com hepatite B foram tratados previamente.Após transplante hepático, a recidiva da hepatite ocorreu em 21 pacientes com hepatite C e nenhum com hepatite B. O tratamento medicamentoso após transplante hepático foirealizado em 13 de 21 dos pacientes com recidiva de hepatite C. Discussão: após transplante hepático em casos de cirrose pelo vírus da hepatite C, a recorrência da infecção é comum e indica necessidade de tratamento efetivo. A sobrevida pós-transplante em pacientes infectados pelo vírus da hepatite B depende da prevenção com uso da profilaxiacombinada. Conclusão: as hepatites virais respondem por importante proporção das indicações de transplante de fígado. A recidiva da hepatite C persiste como o principal problema nos pacientes transplantados por hepatites virais. A profilaxia da recidiva da hepatite B pós-transplante é mandatória com imunoglobulina e análogos de nucleosídeos.
Objectives: to describe the evolution of patients with a diagnosis of viral hepatitis B or C undergoing liver transplantation at a reference hospital. Methods: this was a cross-sectional study conducted in the Organ Transplantation Service of the Alfa Institute of Gastroenterology,General Hospital, Federal University of Minas Gerais, from 2005 to 2007. Data were collected from medical records and service databases. Results: out of 173 patients undergoing liver transplantation, 61 had hepatitis C, nine had hepatitis B, and one developed fulminant hepatitis A. Among patients with hepatitis C, 31 were treated before the transplantation(seven with sustained virological response). Only two patients with hepatitis B were pretreated. After liver transplantation, the recurrence of hepatitis occurred in 21 patients with hepatitis C, and in none with hepatitis B. The drug treatment after liver transplant was performedin 13 out of 21 patients with recurrent hepatitis C. Discussion: in cases of cirrhosis caused by the hepatitis C virus, recurrence of infection is common after liver transplantation and indicates the need for an effective treatment. Post-transplant survival in patients infectedwith hepatitis B virus depends on prevention using combined prophylaxis. Conclusion: viral hepatitis accounts for a significant proportion of indications for a liver transplant.Recurrence of hepatitis C persists as a major problem in transplanted patients due to viral hepatitis. Prophylaxis ofhepatitis B post-transplant recurrence is mandatory withimmunoglobulin and nucleoside analogs.
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BACKGROUND: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE: To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS: This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS: During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). CONCLUSIONS: Shortening time on parenteral nutrition whenever possible and preference ...
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Femenino , Humanos , Recién Nacido , Masculino , Bacteriemia/etiología , Infección Hospitalaria/etiología , Procedimientos Quirúrgicos Operativos/efectos adversos , Bacteriemia/diagnóstico , Bacteriemia/prevención & control , Estudios de Casos y Controles , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/prevención & control , Unidades de Cuidado Intensivo Neonatal , Factores de RiesgoRESUMEN
A doença inflamatória pélvica (DIP) é um processo inflamatório de natureza infecciosa que pode atingir estruturas e órgãos do trato genital superior. Devido à sua importância epidemiológica e de suas graves complicações, este artigo atualiza e propõe uma abordagem sistemática da DIP. Os principais agentes etiológicos são a Neisseria gonorrhoeae,Chlamydia trachomatis e outros agentes etiológicos de uretrites, cervicites, vulvovaginites e vaginoses, em geral, polimicrobiana, o que é a base de sua terapêutica. A mulher deve ser investigada para DIP quando apresenta, especialmente, desconforto abdominal, dor lombar, dispareunia e nódoas ou manchas ao exame ginecológico, previamente a procedimentos transcervicais. A classificação clínico-laparoscópica deDIP pode ser dividida em: a) estágio I (endometrite/salpingite sem peritonite); estágio II (salpingite aguda com peritonite); estágio III (salpingite aguda com oclusão tubária ou abscesso tubo-ovariano); estágio IV (abscesso tubo-ovariano roto). A definição do estágio orienta a conduta e o tratamento, pois em formas leves (estágio I) o tratamento e seguimento podem ser feitos ambulatorialmente, enquanto para os casos moderadosou graves a internação hospitalar está indicada para início do tratamento por via endovenosa e monitorização da resposta ao tratamento. O tratamento suportivo, retirada de dispositivo intrauterino (DIU), abstinência sexual e repouso também são indicados, além de orientações sobre as implicações da doença e abordagem do parceiro.
Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease's epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases.Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tube-ovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.
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Humanos , Femenino , Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedad Inflamatoria Pélvica/etiología , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Chlamydia trachomatis/patogenicidad , Enfermedad Inflamatoria Pélvica/prevención & control , Neisseria gonorrhoeae/patogenicidadRESUMEN
OBJETIVO: Descrever a ocorrência de infecções relacionadas à assistência à saúde em uma unidade neonatal de serviço público de referência em Belo Horizonte, MG, baseando-se em critérios internacionais. MÉTODOS: Trata-se de estudo descritivo, realizado por busca ativa, na Unidade Neonatal de Cuidados Progressivos do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), de 2008 a 2009. A notificação de infecções baseou-se nos critérios do National Healthcare Safety Network (NHSN). O banco de dados e análise foi realizado em programa interno do serviço. RESULTADOS: Foram notificados 325 episódios de infecção nos recém-nascidos, com densidade de incidência de 22,8/1.000 pacientes-dia e incidência proporcional geral de infecção de 36,7%. A sepse foi a principal infecção (62,5%) notificada. A densidade de incidência de infecções foi maior em neonatos com peso menor que 750g (42,4/1.000 pacientes-dia). Observou-se 18,15 episódios de Sepse Relacionada a Cateter/1.000 Cateter Venoso Central-dia e 19,29/1.000 episódios de Sepse Relacionada a Cateter Umbilical/1.000 Cateter umbilical-dia. Em 122 (37,5%) casos de infecção notificada houve isolamento de microorganismos, predominando Staphylococcus coagulase negativo e Staphylococcus aureus (51 casos). A mortalidade e letalidade foram 4,3% e 17,12%, respectivamente. CONCLUSÃO: A utilização de critérios padronizados para notificação de infecções é necessária para a construção de indicadores em neonatologia, que são escassos no país e ressaltam a necessidade de avaliação dos critérios nacionais propostos pela Agencia Nacional de Vigilância ...
OBJECTIVE: To describe occurence of Healthcare Related Infections in a neonatal unit of public reference service in Belo Horizonte-MG, based on international criteria. METHODS: This is a descriptive study, performed by active searching, in the Progressive Care Unit Neonatal Hospital das Clinicas, Federal University of Minas Gerais (HC / UFMG), from 2008 to 2009. Notification of infections was based on National Healthcare Safety Network (NHSN) criteria. The database and analysis were performed in a internal program. RESULTS: A total of 325 episodes of infection in newborns were notified and overall incidence density of infections was 22.8/1,000 patient-days, with a rate of 36.7% of newborns. Sepsis was the main infection (62.5%) reported. The incidence density of infections was higher in neonates weighing lower than 750g (42.4/1,000 patient-days). There were 18.15 episodes of central venous catheter related sepsis/1,000 central venous catheter-day and 19.29 umbilical catheter related sepsis /1,000 umbilical catheter-days. Microorganisms were isolated in 122 (37.5%) cases of reported infections, mainly defined as Staphylococcus coagulase negative and Staphylococcus aureus (51 cases). Mortality and lethality rates were 4.3% and 17,12%, respectively. CONCLUSION: The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA). .
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Humanos , Recién Nacido , Infección Hospitalaria/epidemiología , Notificación de Enfermedades/normas , Monitoreo Epidemiológico , Brasil , Unidades de Cuidado Intensivo Neonatal , InternacionalidadRESUMEN
OBJECTIVE: The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. METHODS: A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. RESULTS: One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-riskhad a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5)vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. CONCLUSION: Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.
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Humanos , Masculino , Femenino , Infecciones Bacterianas , Insuficiencia Renal , Hospitales Universitarios , Antibacterianos , NeutropeniaRESUMEN
Objetivos: avaliar a adesão às recomendações para diagnóstico de sepse relacionada a cateter (SRC), verificando a realização simultânea cultura de ponta de cateter (CPC) e hemocultura de sangue periférico (HP), em um hospital de referência. Métodos: trata-se de estudo transversal, realizado no Hospital das Cínicas da Universidade Federal de Minas Gerais, no período de janeiro de 2007 a outubro de 2009. Os dados foram coletados por profissionais especializados da Comissão de Controle de Infecção Hospitalar. Os critérios de base basearam-se nos critérios de notificação do National Healthcare Safety Network e diretrizes da Infectious Diseases Society of America (IDSA). Os dados foram digitados e analisados pelo Statistical Package for the Social Sciences (SPSS) versão 14.0. Resultados: de 683 CPC com crescimento de microrganismos, apenas 220 (32,2%) apresentaram isolamento de microrganismo em HP concomitante. Desses 220 casos, 74,1% apresentaram crescimento do mesmo microrganismo, com mesmo perfil fenotípico, em ambas as amostras. Nos casos de HP com resultado negativo e casos em que a HP não foi realizada, antimicrobianos foram prescritos em 25,7 e 31,5% dos casos, respectivamente, embora não tenha havido critérios para definição de SRC. Conclusão: apenas da recomendação de realização de CPC pareada com HP, este estudo reflete a prática de realização de CPC isolada e pode estar relacionada ao uso inapropriado de antimicrobianos, aumentando custos da assistência e favorecendo a seleção de resistência bacteriana. O diagnóstico e tratamento da SRC devem ser melhorados e os profissionais devem ser conscientizados das práticas adequadas de manejo de cateter venoso central...
Objectives: This study aims to assess compliance with recommendations for the diagnosis of catheter-related bloodstream infection (CRBSI) at an excellence hospital by verifying simultaneous performance of catheter tip culture (CTC) and peripheral blood culture (PBC). Methods: This is a cross-sectional study conducted at UFMG University Hospital from January 2007 through October 2009. Data were collected by specialized professionals of the Hospital Infection Control Committee. The notification criteria followed those prescribed by the National Healthcare Safety Network and the Infectious Diseases Society of America (IDSA). Database and statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 14.0. Results: Concurrent peripheral blood culture was performed for only 220 (32.2%) of the 683 CTC samples presenting microorganism growth. This points to low compliance with the existing guidelines. Out of the 220 positive CTC paired with PBC results, 74.1% presented the same microorganism, with the same phenotypic profile in both samples. As for negative PBC results and no blood culture testing, antibiotics were prescribed in 25.7 and 31.5% of the cases respectively, despite the inexistence of criteria to determine CRBSI. Conclusions: Despite recommendations for pairing CTC and PBC results, this study points to the common practice of performing isolated CTC tests. This may lead to inappropriate use of antimicrobials, increasing health care costs and selection of resistant bacteria. CRBSI diagnosis and treatment should be improved, and professionals should be aware of adequate practices and management of central venous catheter...
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Humanos , Infecciones Relacionadas con Catéteres , Sepsis/diagnóstico , Bacteriemia , Estudios Retrospectivos , Staphylococcus epidermidis/aislamiento & purificación , Staphylococcus haemolyticus/aislamiento & purificaciónRESUMEN
As infecções hospitalares (IHs), importantes causas de morbimortalidade, são frequentes em recém-nascidos(RNs) internados em unidades neonatais. Para o controle de IH, é importante a orientação aos pacientes e a seusacompanhantes. O objetivo com este trabalho foi avaliar informações assimiladas por mães e acompanhantes de RNsinternados na Unidade Neonatal que participaram de atividades de educação em saúde em prevenção de infecções nosetor. Trata-se de estudo prospectivo, com aplicação de questionários às mães e acompanhantes de RNs na UnidadeNeonatal do Hospital das Clínicas da UFMG, realizado nos meses de agosto de 2008 a abril de 2009. O questionário foiaplicado em duas diferentes amostras: antes e após as orientações de prevenção de infecção. A amostra total foi de268 usuários, sendo que 121 deles receberam a orientação previamente à aplicação do questionário e 147 receberamas informações após o preenchimento deste. Observou-se um percentual de acerto maior após as orientações emtodas as questões e houve diferenças estatísticas significativas (p<0,05) entre os grupos em oito das dez questõesrealizadas. Concluiu-se que essa foi uma medida eficaz para a educação de acompanhantes dos RNs, que adquiriramnoções básicas de infecção após as orientações, por isso podem contribuir para o controle e a prevenção de infecçõesna Unidade e em casa após a alta.
Hospital-acquired infections (HAI) are a major cause of morbidity and mortality and are common in neonatal units. Tocontrol hospital infection it is important to advise patients and their companions on the subject. This study aimed atevaluating the mothers and their companions assimilation of information conveyed during health education activitieson the prevention of hospital-acquired infections. This was a prospective study that applied questionnaires to mothersand companions of newborns admitted to the Neonatal Unit of the Clinics Hospital of the Federal University of MinasGerais (UFMG). The study was carried out from August 2008 to April 2009. The questionnaire was administered intwo different samples: one before and another after the training on infection prevention. Total sample size was 268:121 received the information prior to questionnaire application, and 147 received it after questionnaire filling in.Results indicated that there were a higher percentage of correct answers after the groups were given instructions inall questions. There were significant statistical differences (p<0.05) between groups in eight of the ten questions. Inconclusion, this was an effective educational activity for the newborn companion. He/she acquired basic notions oninfection following the training and therefore may contribute to infection control and prevention in the unit and athome after hospital discharge.
Las infecciones hospitalarias (IH), comunes en recién nacidos (RN) internados en unidades neonatales, son la causaprincipal de morbilidad y mortalidad. Para controlar IH es importante instruir pacientes y cuidadores. El objetivo delpresente estudio fue evaluar las informaciones asimiladas por madres y cuidadores de RN internados en una unidad...
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Salas Cuna en Hospital , Control de Infecciones , Educación en Salud , Infección Hospitalaria/prevención & control , Promoción de la Salud , Salud Materno-Infantil , Vigilancia en DesastresRESUMEN
OBJETIVO: avaliar a implantação de vigilância ativa pós-alta de infecções de ferida cirúrgica (IFC) pós-cesariana na Maternidade Otto Cirne, município de Belo Horizonte, estado de Minas Gerais, Brasil. MÉTODOS: estudo observacional prospectivo, realizado de março/2010 a março/2011; os dados foram obtidos por vigilância ativa, realizada pela Comissão de Controle de Infecção Hospitalar, incluindo contato telefônico seguido de avaliação clínica quando necessária; a notificação seguiu critérios do National Healthcare Safety Network. RESULTADOS: identificaram-se 762 pacientes submetidas a cesariana (29,3 por cento) e fez-se contato telefônico com 500 puérperas; 7 IFC foram notificadas por vigilância passiva (0,9 por cento) e 34 por vigilância ativa (6,8 por cento), com aumento significativo do número de casos identificados (p<0,0001). CONCLUSÃO: a notificação de maior número de casos de IFC pós-cesariana por vigilância ativa reforça a necessidade da identificação de casos de infecção de sítio cirúrgico para reduzir a subnotificação, com referência de puérperas para assistência quando necessário, para definição diagnóstica e tratamento adequado.
OBJECTIVE: to evaluate the implementation of active surveillance post-discharge of Cesarean Surgical- Wound Infections(SWI) at Otto Cirne Maternity, Belo Horizonte, state of Minas Gerais, Brazil. METHODS: prospective observational study conducted from March 2010-2011; data was obtained by active surveillance performed by the Hospital Infection Control Committee, including telephone call followed by clinical evaluation when necessary; notification was performed according to National Healthcare Safety Network criteria. RESULTS: 762 patients who underwent cesarean section (29.3 per cent) were identified and 500 women were contacted; 7 SWI were notified by passive surveillance (0.9 per cent) and 34 by active surveillance (6.8 per cent), with a significant increase on identified cases (p<0.0001). CONCLUSION: notification of number of cases of SWI post-cesarean section by active surveillance emphasizes the need to identify cases of surgical-wound infection to reduce underreporting, referring to postpartum care when necessary for a definitive diagnosis and appropriate treatment.
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Humanos , Masculino , Femenino , Cesárea , Infección de la Herida Quirúrgica , NotificaciónRESUMEN
A doença hepática causada pelo vírus da hepatite C (VHC) é a principal indicação de transplante hepático em todo o mundo. A reinfecção pelo VHC ocorre em praticamente todos os pacientes que apresentam viremia detectável por reação de polimerase em cadeia no momento do transplante, o que se associa a significativa alteração da sobrevida dos órgãos e dos pacientes transplantados. Os fatores que podem influenciar a progressão da lesão hepática pelo VHC ainda não são bem conhecidos. A infecção crônica pelo VHC ocorre em 75 a 90% dos pacientes e 5 a 30% progridem para cirrose em cinco anos. Tratamentos antivirais antes do transplante e profiláticos após o transplante são limitados pela baixa tolerância e efeitos adversos das drogas. O tratamento de lesões estabelecidas no enxerto com interferon ou interferonpeguilado e ribavirinaproduz resposta virológica sustentada em 30 a 40% dos pacientes, mas a modalidade e o momento adequados do tratamento devem ser mais bem estudados. Esta revisão discute os principais aspectos da infecção pelo VHC após o transplante.
Liver disease caused by hepatitis C virus (HCV) is the main reason of indications to liver transplantation worldwide. HCV reinfection takes place in nearly all patients with viremia, whichh is detectable by chain polymerase reaction at transplantation, and has significant effects on the survival of both transplanted organs and patients. Factors influencing HCV liver injury progression are not well known yet. Chronic HCV infection affects 75 ? 90 % of patients and 5 ? 30 % of them develop cirrhosis within 5 years. Antiviral treatments before transplantation and prophylactic treatment after surgery are limited due to low tolerance and side effects. Injury treatment of transplanted organ with interferon or pegylated interferon and ribavarin causes sustained virological response in 30 - 40 % of patients, but the adequate modality and timing are still to be studied. This review discusses the main aspects of post-transplant HCV infection.
RESUMEN
O presente estudo visou realizar uma revisão sistemática da literatura em relação à abordagem das mulheres com doenças sexualmente transmissíveis (DST). As síndromes clínicas abordadas abrangeram uretrites, cervicites, corrimento vaginal e úlceras genitais. A propedêutica indicada incluiu exames diretos e bioquímicos, métodos sorológicos, microbiológicos e de biologia molecular. O tratamento foi recomendado de acordo com o diagnóstico sindrômico ou etiológico, de acordo com a disponibilidade de exames complementares. Além disso, incluiu-se também a abordagem de parceiros, gestantes e mulheres coinfectadas pelo HIV.
This paper presents a systematic literature review on the management of women with sexually transmitted diseases (STD). The clinical syndromes discussed were urethritis and cervicitis, vaginal discharge and genital ulcers. Complementary studies included direct examination and biochemical reactions, serology, microbiological and molecular biology methods. The treatment was recommended in accordance with syndromic or etiologic diagnosis and with the availability of complementary examinations. Moreover, the approach towards partners, pregnant women and HIV co-infected women was also included.
Asunto(s)
Humanos , Femenino , Embarazo , Chancro , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/etiología , Enfermedades de Transmisión Sexual/terapia , Herpes Genital , Sífilis , Conductas Terapéuticas Homeopáticas , Uretritis , Cervicitis Uterina , Vulvovaginitis , Granuloma Inguinal , Linfogranuloma Venéreo , Tamizaje MasivoRESUMEN
Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.
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Adulto , Femenino , Humanos , Masculino , Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/aislamiento & purificación , Resistencia betalactámica , Carbapenémicos , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Infecciones por Acinetobacter/prevención & control , Estudios de Casos y Controles , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Unidades de Cuidados Intensivos/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJETIVO: Comparar quatro métodos laboratoriais no diagnóstico de tuberculose pulmonar. MÉTODOS: Foram realizadas pesquisa direta pelas colorações de Ziehl-Neelsen e auramina, cultura para micobactérias em meio Lõwenstein-Jensen (LJ) e polymerase chain reaction (PCR, reação em cadeia da polimerase) para Mycobacterium tuberculosis em 160 amostras de secreção respiratória de pacientes com suspeita de tuberculose pulmonar. As cepas isoladas foram identificadas por método radiométrico utilizando-se p-nitro-alfa-acetilamino-beta-hidroxipropiofenona (NAP) e métodos clássicos. A sensibilidade dos métodos foi comparada com o padrão ouro para o diagnóstico da tuberculose pulmonar, definido por critérios clínicos, radiológicos e microbiológicos. RESULTADOS: Dos 160 pacientes, 142 foram diagnosticados com tuberculose pulmonar de acordo com o padrão ouro. As técnicas de Ziehl-Neelsen e auramina, cultura em meio LJ e PCR apresentaram sensibilidade de 54,2 por cento, 58,4 por cento, 67,6 por cento e 77,5 por cento, respectivamente, quando comparados ao critério diagnóstico adotado. A especificidade dos quatro métodos foi de 100 por cento. A concordância na identificação da micobactéria entre PCR e o método radiométrico utilizando NAP foi alta (96,8 por cento). A sensibilidade da PCR foi de 50,8 por cento nas amostras com baciloscopia negativa e de 98,8 por cento naquelas com baciloscopia positiva. Nas amostras com resultados negativos na baciloscopia e cultura, a sensibilidade da PCR foi menor que nas com resultados positivos (25,6 por cento e 99,0 por cento, respectivamente). CONCLUSÕES: A PCR é método promissor no diagnóstico da tuberculose pulmonar, mesmo em amostras paucibacilares. Além disso, apresenta a vantagem da identificação simultânea e rapidez do resultado.
OBJECTIVE: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. METHODS: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen and auramine staining. In addition, culture in Lõwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR) were used. The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. RESULTS: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture in LJ medium and PCR was 54.2 percent, 58.4 percent, 67.6 percent and 77.5 percent, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100 percent specificity. In the identification of mycobacteria, there was high (96.8 percent) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8 percent in samples with negative sputum smear microscopy results and 98.8 percent in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6 percent and 99.0 percent, respectively). CONCLUSIONS: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Técnicas Bacteriológicas/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Esputo/microbiología , Coloración y Etiquetado/métodos , Tuberculosis Pulmonar/diagnóstico , Benzofenoneido , Colorantes , Medios de Cultivo , Interpretación Estadística de Datos , Hidroxipropiofenona/análogos & derivados , Hidroxipropiofenona , Mycobacterium tuberculosis/genética , Sensibilidad y Especificidad , Tuberculosis Pulmonar/genética , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
Objetivos: o objetivo do presente estudo é estabelecer notificação de infecções hospitalares (IH) de pacientes submetidos ao transplante hepático (TH), pois as complicações infecciosas são importante causa de morbimortalidade dessa população.Métodos: trata-se de estudo observacional prospectivo, para notificação de IH de pacientes submetidos ao TH, no período de 2000-2005, no Hospital das Clínicas/UFMG. Todos os pacientes foram incluídos a partir do procedimento e seguidos durante um ano. A notificação das IHs baseou-se no National Nosocomial Infection Surveillance System (NNISS). Os dados foram analisados pelos programas EpiInfo e Excel. Resultados: no período do estudo, foram realizados 311 transplantes e notificadas 276 infecções, correspondendo a uma taxa de IH de 88,7 infecções por 100 transplantes. O tempo médio de ocorrência da primeira IH foi de 9,5 dias. As principais infecções foram: olhos/ouvidos/nariz/garganta (24,3 por cento), infecções de sítio cirúrgico (12,7 por cento), infecções de corrente sangüínea (21,4 por cento) e pneumonias (13,8 por cento). Das culturas realizadas, 177 (64,1 por cento) foram positivas, sendo principalmente de sítio cirúrgico (66 casos). Os principais microrganismos foram: Staphylococcus coagulase negativo (18,6 por cento), Staphylococcus aureus (15,2 por cento) e Pseudomonas aeruginosa (15,2 por cento). Conclusões: a aplicação dos critérios de IH definidos pelo NNISS nesses pacientes permitiu avaliação temporal das taxas de infecção nessa população e comparação com outros serviços, direcionando medidas de controle e prevenção de IH.