RESUMO
OBJECTIVE: To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting. DESIGN: Evaluation of costs and savings, using historical control data. SETTING: Adult oncology unit of a 650-bed hospital. PARTICIPANTS: Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients. METHODS: Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model. RESULTS: The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings. CONCLUSION: The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least six to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.
Assuntos
Bacteriemia/prevenção & controle , Infecção Hospitalar/prevenção & controle , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/prevenção & controle , Custos Hospitalares/estatística & dados numéricos , Controle de Infecções/economia , Serviço Hospitalar de Oncologia/economia , Resistência a Vancomicina , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/economia , Controle de Custos , Redução de Custos , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/economia , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/economia , Hospitais com mais de 500 Leitos , Humanos , Controle de Infecções/métodos , Tempo de Internação/economia , New York , Vancomicina/farmacologia , Vancomicina/uso terapêuticoRESUMO
Erythematous rashes that are suggestive of early Lyme disease have been associated with the bite of Amblyomma americanum ticks, particularly in the southern United States. However, Borrelia burgdorferi, the causative agent of Lyme disease, has not been cultured from skin biopsy specimens from these patients, and diagnostic serum antibodies usually have not been found. Borrelia lonestari sp nov, an uncultured spirochete, has been detected in A. americanum ticks by DNA amplification techniques, but its role in human illness is unknown. We observed erythema migrans in a patient with an attached A. americanum tick. DNA amplification of the flagellin gene flaB produced B. lonestari sequences from the skin of the patient that were identical to those found in the attached tick. B. lonestari is a probable cause of erythema migrans in humans.
Assuntos
Mordeduras e Picadas/complicações , Infecções por Borrelia/etiologia , Borrelia/isolamento & purificação , Eritema Migrans Crônico/etiologia , Carrapatos , Idoso , Sequência de Aminoácidos , Animais , Anticorpos Antibacterianos/sangue , Sequência de Bases , Biópsia , Borrelia/genética , Borrelia/imunologia , Infecções por Borrelia/diagnóstico , DNA Bacteriano/análise , Diagnóstico Diferencial , Amplificação de Genes , Humanos , Masculino , Dados de Sequência Molecular , Técnicas de Amplificação de Ácido Nucleico , Estados UnidosRESUMO
GOAL: To describe the reoccurrence of ecthyma gangrenosum (EG) in two patients with acquired immunodeficiency syndromes (AIDS). OBJECTIVES: 1. To describe the clinical characteristics of EG. 2. To discuss causative organism and risk factor for EG in patients with AIDS. 3. To identify rates of relapse/recurrence of EG in patients with AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Ectima/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Ectima/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/patologia , RecidivaRESUMO
BACKGROUND: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals. OBJECTIVE: To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting. DESIGN: Prospective cohort study. SETTING: Adult oncology inpatient unit. PATIENTS: 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices. INTERVENTIONS: Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed. MEASUREMENTS: VRE infection rates, VRE colonization rates, and changes in antimicrobial use. RESULTS: During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced. CONCLUSION: Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/prevenção & controle , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/prevenção & controle , Controle de Infecções , Vancomicina/farmacologia , Adulto , Resistência Microbiana a Medicamentos , Humanos , Serviço Hospitalar de Oncologia , Estudos ProspectivosRESUMO
BACKGROUND: After the occurrence of two cases of bloodstream infection with vancomycin-resistant enterococci (VRE) in our regional neonatal intensive care unit, we studied the epidemiology of VRE and applied extensive infection control measures to the unit to control VRE transmission. METHODS: Infection control measures applied to the unit included weekly surveillance for VRE colonization; education; cohorting of VRE-positive, VRE-negative and VRE-exposed babies with separate personnel and equipment for each group; use of gowns and gloves on room entry; and hand washing before and after each patient contact. Risk factors for VRE colonization were determined with a stepwise logistic regression model. RESULTS: Thirty-three (40.2%) babies became colonized with VRE. The VRE colonization rate was reduced from 67% to 7% after implementation of infection control measures. Prolonged antimicrobial treatment and low birth weight were significantly associated with an increased risk of VRE colonization. CONCLUSION: VRE can spread rapidly among newborns in a regional neonatal intensive care unit. Strict infection control measures can reduce the rate of VRE colonization among neonates.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/prevenção & controle , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/prevenção & controle , Vancomicina/farmacologia , Infecção Hospitalar/epidemiologia , Resistência Microbiana a Medicamentos , Eletroforese em Gel de Campo Pulsado , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Recém-Nascido , Controle de Infecções , Unidades de Terapia Intensiva Neonatal , Fatores de RiscoAssuntos
Antibacterianos/farmacologia , Enterococcus/efeitos dos fármacos , Fezes/microbiologia , Vancomicina/farmacologia , Adulto , Resistência Microbiana a Medicamentos , Enterococcus/isolamento & purificação , Feminino , Bactérias Aeróbias Gram-Negativas/efeitos dos fármacos , Bactérias Aeróbias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Fatores de RiscoRESUMO
OBJECTIVES: To describe the population in whom bloodstream infections with vancomycin-resistant enterococci occur and the clinical and microbiologic features of infection. METHODS: From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records. RESULTS: Fifty-two (73%) of 71 patients with evaluable data were hospitalized in an intensive care, unit, the adult oncology unit, or the acquired immunodeficiency syndrome unit. Before the development of the bloodstream infection with vancomycin-resistant enterococci, patients were hospitalized and received antibiotics for a median of 26 and 25.5 days, respectively. A hematologic malignancy, respiratory failure, or renal failure requiring dialysis was present in 59 patients (83%). Acute Physiology and Chronic Health Evaluation II scores of the patients ranged from 6 to 35 (median, 17). Forty-five (63%) of the patients died. Compared with 37 patients who had only a single positive blood culture, the 34 patients with 2 or more blood cultures positive for vancomycin-resistant enterococci more often were neutropenic or had acquired immunodeficiency syndrome (74% vs 35%; P = .002). CONCLUSIONS: Bloodstream infections with vancomycin-resistant enterococci predominantly affect severely ill patients who have received extensive antibiotic treatment during a prolonged hospitalization. Immunocompromised patients are more likely to have a persistent blood-stream infection with vancomycin-resistant enterococci.
Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Vancomicina/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/imunologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/imunologia , Resistência Microbiana a Medicamentos , Enterococcus/isolamento & purificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/imunologia , Hospitais Universitários , Humanos , Hospedeiro Imunocomprometido/imunologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine the incidence, duration, and genetic diversity of colonization with vancomycin-resistant Enterococcus faecium (VREF). SETTING: Oncology unit of a 650-bed university hospital. METHODS: Surveillance perianal swab cultures were performed on admission and weekly. The molecular relatedness of VREF isolates was determined by pulsed-field gel electrophoresis and by the hybridization pattern of the vanA resistance determinant. RESULTS: During 8 months of surveillance, the VREF colonization rate was 16.6 patients per 1,000 patient-hospital days, which was 10.6 times greater than the VREF infection rate. Eighty-six patients with VREF colonization were identified. Colonization persisted for at least 7 weeks in the majority of patients. Of 36 colonized patients discharged from the hospital and then readmitted, an average of 2 1/2 weeks later, 22 (61%) patients still were colonized with VREF. Of the 14 patients who were VREF-negative at readmission, only three patients remained culture-negative throughout hospitalizations. PFGE demonstrated that colonization with the same VREF isolate may persist for at least 1 year, and patients may be colonized with more than one strain of VREF. CONCLUSION: VREF colonization is at least 10-fold more prevalent than infection among oncology patients. Colonization often persists throughout lengthy hospitalizations and may continue for long periods following hospitalization.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/epidemiologia , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Vancomicina/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/complicações , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Impressões Digitais de DNA , Resistência Microbiana a Medicamentos , Eletroforese em Gel de Campo Pulsado , Enterococcus faecium/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Humanos , Pessoa de Meia-Idade , Neoplasias/complicações , New York/epidemiologia , Serviço Hospitalar de Oncologia , Isolamento de Pacientes , Prevalência , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
OBJECTIVE: To determine the proportion of major surgical procedures that involve patients having serologic evidence of infection with human immunodeficiency virus-1 (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in a single center in Westchester County, New York. METHODS: Blood samples sent for transfusion screening or cross-match were tested blindly for HIV antibody (anti-HIV), HBV core antibody, HBV surface antigen (HBsAg), and HCV antibody (anti-HCV). Demographic characteristics and operation category were correlated with serologic results by univariate and regression analyses. RESULTS: Of 1,062 operations evaluated, 71 (6.7%, 95% confidence interval [CI95], 5.2% to 8.4%) were performed on patients with either anti-HIV, HBsAg, or anti-HCV. In 17 (1.6%, CI95, .93% to 2.5%) of these operations, the patient evidenced anti-HIV; in 15 (1.4%; CI95, .79% to 2.3%), HBsAg; and in 55 (5.2%, CI95, 3.9% to 6.7%), anti-HCV. Anti-HCV was detected significantly more often than anti-HIV (5.2% versus 1.6%, P < .001) or HBsAg (5.2% versus 1.4%, P < .001). Operations involving women aged 25 to 44 years had the highest proportion with serologic evidence of at least one of the three viruses (17.2%); of anti-HCV (15.3%); and of anti-HIV (6.7%). Logistic regression analysis found that being in the 25- to 44-year age group was associated significantly with infection with any virus (P < .001) and with anti-HCV (P < .001). The strongest logistic predictors of anti-HIV seropositivity were having anti-HCV seropositivity (P < .001), being age 25 to 44 years (P < .001), and having a general surgery operation (P = .002). CONCLUSION: The prevalences of serologic evidence of at least one of the three viruses (16.7%), of anti-HCV (14.5%), and of anti-HIV (5.6%) are high in patients aged 25 to 44 years undergoing major surgery at a tertiary-care medical center located in Westchester County, New York. Anti-HCV is more prevalent than anti-HIV or HBsAg and is predictive of anti-HIV seropositivity. Testing for anti-HIV alone would have detected only 24% of patients infected with a bloodborne pathogen. These data strongly underscore the importance of universal precautions.
Assuntos
Infecções por HIV/epidemiologia , HIV-1 , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Adulto , Distribuição por Idade , Idoso , Patógenos Transmitidos pelo Sangue , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prevalência , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
OBJECTIVE: To compare the frequency of occupational injuries reported by surgeons in 1993 with similar data obtained in 1988. DESIGN AND SETTING: Two point-prevalence studies of percutaneous injuries of surgeons practicing in tertiary and non-tertiary-care hospitals in the New York metropolitan area. PARTICIPANTS: A total of 202 surgeons and surgical residents surveyed in 1988 and 347 surveyed in 1993 (67 and 65% of the eligible groups, respectively), including 85 surgeons in 1993 (71% of the eligible group) who had participated in the 1988 survey. OUTCOME MEASURES: Yearly frequency of percutaneous injuries, and injury frequency per 1000 operative hours. RESULTS: There was a significant decrease in the frequency of reported percutaneous injuries over the 5-year period. For all surgeons, the mean number of yearly injuries decreased from 5.5 +/- 14.4 SD to 2.1 +/- 6.0 SD (P < or = 0.001). Paired analysis of the subgroup of 85 surgeons who participated in both surveys showed a nearly identical decrease (P = 0.001). Significant decreases were observed in general surgeons, specialists and residents. CONCLUSIONS: During the 5 years studied, surgeons practicing in the greater New York metropolitan area reported a significant reduction in the frequency of occupationally associated percutaneous injuries. The reduced risk of percutaneous injuries should substantially lower the rate of acquired infections from blood-borne pathogens.
Assuntos
Cirurgia Geral , Infecções por HIV/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Doenças Profissionais/etiologia , Pele/lesões , Adulto , Feminino , HIV/patogenicidade , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , New York , Doenças Profissionais/epidemiologia , Fatores de Risco , Pele/virologiaRESUMO
BACKGROUND: Because occupational blood contact places health-care workers at risk for infection with bloodborne pathogens, we wanted to estimate the prevalence of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among hospital-based surgeons and correlate the results with occupational and nonoccupational risk factors. STUDY DESIGN: All surgeons in training or in practice in general surgery, obstetrics and gynecology, or orthopedics at 21 hospitals in moderate to high AIDS incidence areas were eligible to participate in a voluntary, anonymous serosurvey. Serum samples were tested for HIV antibody, for HCV antibody, and for markers of HBV infection: hepatitis B surface antigen, total antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. RESULTS: Of 2,887 eligible surgeons, 770 (27 percent) participated in the study. One of 740 surgeons not reporting nonoccupational risk factors was HIV seropositive (0.14 percent, upper limit 95 percent confidence interval [CI] equals 0.64 percent). None of 20 participants reporting nonoccupational HIV risk factors and none of ten not responding to the question on nonoccupational risk factors were HIV positive. Of 129 (17 percent) participants with past or current HBV infection, three (0.4 percent) had chronic HBV infection; all were negative for hepatitis B e antigen. Risk factors for HBV infection included not receiving hepatitis B vaccine (odds ratio [OR] 14.7, 95 percent CI 8.3 to 26.0) and practicing surgery at least ten years (OR 2.2, 95 percent CI 1.3 to 3.8). Seven (0.9 percent) participants had anti-HCV. CONCLUSIONS: Although not necessarily generalizable to all surgeons in moderate to high AIDS incidence areas, these results do not indicate a high rate of previously undetected HIV infection among surgeons who trained or practiced in these areas, or both. Hepatitis B virus posed the highest risk of infection with a bloodborne pathogen, followed by HCV and HIV.
Assuntos
Cirurgia Geral , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Doenças Profissionais/epidemiologia , Hospitais Urbanos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , New York/epidemiologia , Razão de Chances , Prevalência , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
Because of the human immunodeficiency virus epidemic, skin testing for Mycobacterium tuberculosis is now performed in conjunction with control skin tests to assess anergy and thus provide information to aid in the interpretation of a negative tuberculin test. However, anergy can occur selectively to purified protein derivative tuberculin when reactions to other recall antigens are present. We report an illustrative case of selective anergy in a patient with tuberculous meningitis and review the literature on this poorly understood phenomenon. When one suspects M. tuberculosis disease, repeating a 5 unit PPD-tuberculin skin test after four to eight weeks of antituberculous treatment may assist in establishing or excluding the diagnosis of tuberculosis.
Assuntos
Anergia Clonal , Tuberculina/imunologia , Tuberculose Meníngea/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Teste TuberculínicoAssuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Microbiologia da Água , Abastecimento de Água , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Habitação , Humanos , Infecção por Mycobacterium avium-intracellulare/prevenção & controleRESUMO
An outbreak of bacteremia caused by Enterococcus faecium with high-level resistance to vancomycin (MIC of > or = 256 micrograms/ml), ampicillin (MIC of > or = 64 micrograms/ml), and gentamicin or streptomycin (MIC of > or = 2,000 micrograms/ml) occurred in an adult oncology unit from June 1991 to May 1992. Active surveillance for the presence of this organism in stool or perianal cultures was begun in September 1991. Between June 1991 and May 1992, seven patients with bacteremia and 22 noninfected carriers of the organism in stool were identified. The vanA gene, tested for by PCR and gene probe, was present in all isolates evaluated. All bacteremic patients also had resistant E. faecium present in a stool or perianal culture; the stool isolates tested were closely related to the respective blood isolates as determined by pulsed-field gel electrophoresis. Antibiotic regimens using high-dose ampicillin and an aminoglycoside were ineffective with four patients. Five patients (71%) had multiple positive blood cultures; four of these patients died. Following a multiple logistic regression analysis, it was found that bacteremic patients received a significantly greater number of total antibiotic days compared with noninfected stool carriers (P = 0.019). The emergence of E. faecium with high-level resistance to vancomycin, ampicillin, and aminoglycosides underscores the importance of performing susceptibility testing on all clinically significant isolates. In the neutropenic adult oncology patient, bacteremia with this organism is of probable gastrointestinal origin, is often persistent, and is refractory to treatment with ampicillin in combination with an aminoglycoside. Prolonged use of antibiotics may predispose patients with gastrointestinal colonization to develop bacteremia.
Assuntos
Ampicilina/farmacologia , Antibacterianos/farmacologia , Bacteriemia/epidemiologia , Surtos de Doenças , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Vancomicina/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminoglicosídeos , Bacteriemia/tratamento farmacológico , Resistência Microbiana a Medicamentos , Fezes/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in ICU patients randomized to gastric tube feeding vs. patients fed by an endoscopically placed jejunal tube. DESIGN: Randomized, prospective study. SETTING: Medical and surgical ICUs at Boston City Hospital; surgical ICU at University Hospital. PATIENTS: Of the 38 study patients, 19 were randomized to gastric tube feeding and 19 were randomized to an endoscopically placed jejunal tube. The two groups were similar in age, sex, race, underlying disease, and type of surgery. RESULTS: The two patient groups were similar in number of days fed, duration of ICU stay, duration of mechanical ventilation, days of antibiotic therapy, and days with fever. Compared with the gastric group, the jejunal group had more patients with circulatory shock on admission (79% vs. 68.4%), higher admission Acute Physiology Score (24.0 vs. 21.7), and fewer patients with pneumonia at randomization (26.3% vs. 31.6%). The jejunal group received a significantly higher percentage of their daily goal caloric intake (p = .05), and had greater increases in serum prealbumin concentrations (p < .05) than the patients with gastric tube feeding. Although the jejunal tube group had more days of diarrhea (3.3 +/- 6.6 vs. 1.8 +/- 2.9), this difference was not statistically significant. Nosocomial pneumonia was diagnosed clinically in two (10.5%) patients in the gastric tube group and in no patients in the jejunal tube group. CONCLUSIONS: Patients fed by jejunal tube received a significantly higher proportion of their daily goal caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous gastric tube feeding.
Assuntos
Infecção Hospitalar/epidemiologia , Nutrição Enteral/efeitos adversos , Gastrostomia/efeitos adversos , Jejunostomia/efeitos adversos , Estado Nutricional , Pneumonia Aspirativa/epidemiologia , Adulto , Boston/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Endoscopia Gastrointestinal , Ingestão de Energia , Nutrição Enteral/métodos , Feminino , Gastrostomia/enfermagem , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Jejunostomia/enfermagem , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/microbiologia , Pré-Albumina/análise , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estômago/microbiologia , Resultado do TratamentoRESUMO
Hospital-acquired pneumonia is the second most common nosocomial infection in the United States. Aspiration appears to be the major route for the entry of microorganisms into the lower respiratory tract. Nosocomial pneumonia may be caused by bacteria, viruses and fungi. Aerobic gram-negative bacilli and Staphylococcus aureus are the most common etiologic agents, but infection is usually polymicrobial. Risk factors for nosocomial pneumonia include host variables, colonization with nosocomial pathogens, and impaired response of pulmonary defenses to the microbial challenge. Bacteria causing nosocomial pneumonia may be part of the patient's endogenous flora, originate from the hands of hospital personnel, or result from the use of invasive devices. The mechanically ventilated patient has multiple risk factors that contribute to the high rate of nosocomial pneumonia. An understanding of the epidemiology and risk factors for nosocomial pneumonia is fundamental for implementation of preventive strategies to reduce patient morbidity, mortality, and hospital costs.