Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: a case-case-control design in a prospective cohort study.

BACKGROUND: Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. METHODS: We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. RESULTS: Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77-10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17-15.18), carbapenem use (OR = 3.42; 95% CI 1.37-8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01-1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72-27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07-26.45) were factors associated with CS-GNB sepsis. CONCLUSIONS: The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.

Impact of a single safety-engineered device on the occurrence of percutaneous injuries in a general hospital in Brazil.

BACKGROUND: Health care workers are exposed to bloodborne pathogens through occupational injuries, and the replacement of sharps by safety-engineered devices has been recommended as a key preventive measure. This recommendation has been difficult to implement in Brazil. METHODS: We conducted a retrospective study of selected data from a database of blood and body fluid exposures reported from January 2007 through December 2011 in a public general hospital in Rio de Janeiro where, from the end of 2009, a safety lancet for blood glucose testing (BGT) was introduced. A log-binomial model was used to evaluate the effect of the introduction of the safety lancet on the proportion of percutaneous injuries (PIs) during BGT in the nursing staff. RESULTS: Nursing staff had a significant reduction in rate of PIs per 100 full-time equivalents from 2007 to 2011 (P < .001), and medical residents had the highest rate throughout the same period. A reduction of PIs by small-gauge needles was observed since 2009, and injuries during BGT fell abruptly in 2010 and 2011 paralleling the number of purchased safety lancets (P < .001). CONCLUSION: The adoption of a single safety device, which required no training, significantly reduced PIs among the nursing team.