The impact of ageing on the incidence and mortality rate of bloodstream infection: A hospital-based case-cohort study in a tertiary public hospital of Brazil.

OBJECTIVE: Over the past few decades, life expectancy in Brazil has increased from 48 years in 1950s to 76 years in 2017. The aim of this study was to investigate the impact of ageing on: (1) the frequency of hospitalisations due to bloodstream infection (BSI); (2) the incidence of hospital-acquired BSI (H-BSI); (3) the incidence of BSI caused by multidrug-resistant (MDR) agents and (4) the mortality rate of BSI in a public hospital. METHODS: A hospital-based case-cohort study was conducted between 1 December 2013 and 31 December 2015. The data were analysed using multivariable logistic regression. RESULTS: A total of 500 BSI episodes were detected, among 11,102 hospitalizations. The incidence of hospitalisations resulting from BSI was significantly higher in older than younger patients (3.7/100 vs. 2.0/100, p < 0.01). Similarly, the incidence of hospital-acquired BSI was significantly higher in older patients (2.7/100 vs. 0.9/100, p < 0.01). Klebsiella pneumoniae (15.9%), Staphylococcus aureus (14.3%), Escherichia coli (13.1%) and Acinetobacter spp. (12.1%) were the most common agents isolated. MDR agents caused 37.6% of the BSI episodes; enteric Gram-negative bacilli resistant to third- or fourth-generation cephalosporins (9.7%) and carbapenem-resistant Acinetobacter spp. (9.2%) were the most common MDR agents. The following complications were independently associated with ageing: Charlson comorbidity index (OR = 1.16; 95% CI = 1.09-1.24); BSI secondary to urinary tract infection (OR = 2.14; 95% CI = 1.29-3.55); BSI secondary to pneumonia (OR = 1.77; 95% CI = 1.07-2.93) and 30-day mortality following BSI (OR = 2.19; 95% CI = 1.43-3.36). CONCLUSIONS: These data suggest ageing has a significant impact on hospitalisations due to BSI, H-BSI incidence and mortality from BSI in older patients attending a Brazilian public hospital. Age was not significantly associated with MDR-related BSI. These results indicate that age plays an important role in the increase in morbidities and mortality resulting from BSI in Brazil and that with the increased life expectancy observed over recent decades in Brazil, the burden of BSI will be expected to continue to increase. This dynamic needs to be better understood with additional studies.

Uncaria tomentosa in the treatment of the herpes labialis: randomized double-blind trial / Uncaria tomentosa no tratamento de herpes labial: estudo duplo-cego randomizado

Introduction: the lesions caused by herpes simplex are common and have symptoms affecting the quality of life of affected people. Objective: this study aims to assess the safety efficacy of cream with Uncaria tomentosa (cat?s claw), for topical treatment of the herpes labialis. Methods: a clinical investigation was undertaken by means of controlled, randomized, double-blinded protocol in humans. According to the regulatory procedures, 74 patients were selected based on inclusion/exclusion criteria previously submitted to the Local Ethical Committee (no 144/02) whenever herpes labialis lesion appeared. Following, those selected through medical evaluation received either the test (Uncaria) or the reference (Acyclovir) drug. Results: fifty-four episodes of herpes labialis lesions ecloded in 31 volunteers. After their clinical assessment, one showed 4 episodes, two had 3 episodes and six had 2 infections. Hence, 27 patients received the reference drug while 27 applied the Uncaria cream four times a day. Overall, there were not significant differences between either responses. Although, the Uncaria group showed lower scores on the first two days of treatment (p < 0,005; t = 0,028), on day 3, it was even to Acyclovir. Conclusion:the assessment of clinical efficacy of either treatment demonstrated that both drugs were safe as no adverse reactions were reported. Futher, there was no difference (p > 0,05) in the overall period infections as well as in the inflammatory process or crost formation. Regarding the severity of inflammatory reaction, the clinical efficacy of Uncaria tomentosa was significantly better than acyclovir. Rather than the being antiviral drug, the Uncaria tomentosa may act as an anti-inflammatory agent and this would possibly represent an advantage of not inducing viral resistance for long use.

Introdução: as lesões causadas por herpes simples são comuns e apresentam sintomatologia que altera a qualidade de vida das pessoas acometidas. Objetivo: este estudo visa avaliar a eficácia da segurança de creme com Uncaria tomentosa (unha-de-gato) para o tratamento tópico de herpes labial. Métodos: a pesquisa clínica foi realizada por meio de protocolo controlado, randomizado e duplo-cego. De acordo com os procedimentos de regulamentação, 74pacientes foram selecionados com base em critérios de inclusão e exclusão previamente submetidos à Comissão de Ética Local (no 144/02), sempre a lesão de herpes labial apareceu. Em seguida, os selecionados através de avaliação médica receberam o produto-teste (Uncaria) ou o de referência (aciclovir).Resultados: cinquenta e quatro episódios de lesões de herpes labial eclodiram em 31 voluntários. Após a avaliação clínica, um apresentou quatro episódios, dois tiveram três episódios e seis tinham duas infecções. Assim, 27 pacientes receberam a droga de referência, enquanto 27 aplicaram o creme Uncaria quatro vezes por dia. Em geral, não houve diferença significativa entre as respostas. Contudo, o grupo de Uncaria apresentou escores inferiores nos dois primeiros dias de tratamento (p < 0,005 t = 0,028), depois do dia 3, foi similar ao aciclovir. Conclusão: a avaliação da eficácia clínica dos tratamentosdemonstraram que ambas as drogas foram seguras, bem como não foram notificadas reações adversas. Além disso, não houve diferença significativa (p 0,05) no período total de infecções, bem como no processo inflamatório ou na formação de crosta. Quanto à gravidade da reação inflamatória, a eficácia clínica da Uncaria tomentosa foi significativamente melhor do que o aciclovir. Em vez de a droga ser antiviral, a Uncaria tomentosa pode atuar como um agente anti-inflamatório e isso, possivelmente, representa uma vantagem de não induzir resistência viral para uso por muito tempo.