RESUMO
Abstract Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Resumen Achromobacter spp. son reconocidas con mayor frecuencia como patógenos emergentes en pacientes con fibrosis quística e inmunodeprimidos, pero son inusuales en hospedadores inmunocompetentes o quirúrgicos. En este estudio describimos 2 eventos simultáneos atribuibles a 2 fuentes contaminadas con Achromobacter spp. Uno correspondió a un episodio de seudobacteriemia por tubos de citrato de sodio contaminados con Achromobacter insuavis y el otro a infecciones y colonizaciones debidas al uso de solución jabonosa de clorhexidina intrínsecamente contaminada con Achromobacter genogrupo 20. Ambos episodios pusieron en peligro el uso apropiado de antimicrobianos. Los enfoques moleculares fueron fundamentales para lograr la identificación precisa de las especies y evaluar la relación clonal de los aislamientos, lo que refuerza la necesidad del trabajo perseverante y multidisciplinario de microbiólogos, especialistas en enfermedades infecciosas, epidemiólogos y enfermeras en el control de infecciones para el esclarecimiento de estas situaciones epidemiológicas.
RESUMO
Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Assuntos
Achromobacter , Infecção Hospitalar , Infecções por Bactérias Gram-Negativas , Achromobacter/genética , Clorexidina , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Sabões , Citrato de SódioRESUMO
UNLABELLED: This study investigates the implementation of an alert system for the isolation of vancomycin resistant enterococci (VRE) colonized patients. Given the risk of admitting a patient colonized by VRE it is necessary to implement efficient isolation measures. An electronic alert system integrated into a health information system (HIS) could help with the detection of these patients and their isolation in proper units. OBJECTIVES: Determine the efficacy of an electronic alert system in improving the rate of properly isolation of patients colonized with VRE. METHODS: two consecutive series of admission in adults units of 67 patients that were infected or colonized with VRE were compared. The time period of the study was six months before the implementation of the alert system and six months post-implementation of the system. RESULTS: The proportion of admission with proper isolation of the patient in correct units increased 44% after the alert system implementation. CONCLUSION: The implementation of an alert system improved the proportion of properly isolated patients with VRE.
Assuntos
Infecção Hospitalar/prevenção & controle , Registros Eletrônicos de Saúde , Enterococcus , Registros de Saúde Pessoal , Sistemas de Registro de Ordens Médicas , Isolamento de Pacientes , Resistência a Vancomicina , Alarmes Clínicos , Humanos , Armazenamento e Recuperação da Informação/métodos , Interface Usuário-ComputadorRESUMO
La alta incidencia de infección en los drenajes ventriculares externos (0-45) representa un serio problema para los pacientes y las instituciones no sólo en el aspecto médico sino también en el económico y legal. Consideramos que la sistematización y la aplicación multidisciplinaria de guías de manejo son de gran importancia para la prevención de la infección. Por lo cual se debatieron los puntos de controversia en un grupo interdisciplinario constituido por especialistas en neurocirugía, terapia intensiva e infectología, enfermeros de terapia intensiva y el comité de infecciones, realizando por consenso las recomendaciones. Palabras clave: guía de manejo, infección, profilaxis antibiótica, ventriculitis, ventriculostomía.
The high incidence of infections fo the external ventricular drainages (0-45) represents a serious problem for patients and institutions not only in the medical aspects, but also int economic and legal ones. We believe that the systematic and multidisciplinary application of guides is of grat value for the prevention of infections. Based on the controversial points, a group comprised by neurosurgeons, intensive care phisicians, intensive care nurses, infectologists and the hospital infections comittee, discussed these issue and wrote the recomendations. Key words: antibiotics prophylaxis, infection, management guidelines, ventriculitis, vetriculostomy.