RESUMO
Little is known about the role of lineage of strains of Clostridioides difficile (CD) on the clinical presentation of CD infection (CDI) in Latin America, especially regarding the treatment response. We conducted a multicenter, prospective study to investigate the predictive factors and treatment outcomes of CDI in hospitalized patients and to performed phenotypical and molecular characterization of CD strains. A total of 361 diarrheic patients at 5 hospitals from different regions of the country were enrolled. All stool samples were tested for glutamate dehydrogenase (GDH), toxins A and B, and toxin genes using a nucleic acid amplification test (NAAT). Specimens were cultured and susceptibility profile and whole-genome sequencing (WGS) were performed. CDI positivity was 15% (56/377). Predictive factors for CDI were prior use of meropenem (OR 4.09, 95% CI 2.097-7.095; p<0.001), mucus in stools (OR 3.29; 95% CI 1.406-7.722; p=0.006) and neutrophil left-shift with >20% of bands (OR 3.77; 95% IC 1.280-11.120; p=0.016). Overall mortality was 19%, with no deaths attributed to CDI. Oral metronidazole was used in 74% of cases, with 85% of cure and 14% of recurrence. A total of 35 CD isolates were recovered, all of them susceptible to metronidazole and vancomycin. The WGS revealed 17 different STs, six of which were novel. ST42 was the most common ST and hypervirulent strains were not found. Severe CDI were caused by ST42, ST5, ST8, ST48, ST33 and a novel ST667. The ermB gene was more frequently found in isolates of ST42 (p=0.004).
Assuntos
Antibacterianos/uso terapêutico , Clostridioides difficile/genética , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Diarreia/microbiologia , Adulto , Idoso , Proteínas de Bactérias/genética , Brasil/epidemiologia , Clostridioides difficile/classificação , DNA Bacteriano/genética , Fezes/microbiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Sequenciamento Completo do GenomaRESUMO
Epidemiological data on CD infection (CDI) in Latin American are scarce. CDI prevalence and strains characterization were prospectively evaluated in 5 Brazilian hospitals from different regions. Prevalence rates of CDI were 15%, ranging from 0 to 37%. ST42 was the most common Sequence Type and hypervirulent strains were not identified.
Assuntos
Clostridioides difficile/classificação , Infecções por Clostridium/epidemiologia , Diarreia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Brasil/epidemiologia , Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , DNA Bacteriano , Diarreia/microbiologia , Fezes/microbiologia , Feminino , Glutamato Desidrogenase/genética , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Sequenciamento Completo do Genoma , Adulto JovemRESUMO
Clostridioides difficile (CD) is the most frequent cause of healthcare related diarrhea and its severity has increased in the last decade by the spread of hypervirulent strains. Most important CD virulence factor is toxin production; however, not only toxins are responsible for Clostridioides virulence. We sequenced 38 strains and analyzed the presence and integrity of 24 virulence (including toxin) genes. We identified 28 toxigenic strains, six also presented the cdt genes. Only six strains didn't present all others genes searched. All absent genes were adhesion related. Understand others CD virulence factors can lead to a best understanding on this matter.
Assuntos
Toxinas Bacterianas , Clostridioides difficile , Infecções por Clostridium , Toxinas Bacterianas/genética , Brasil , Clostridioides , Clostridioides difficile/genética , Hospitais , Humanos , Virulência/genética , Fatores de Virulência/genética , Sequenciamento Completo do GenomaRESUMO
Objetivo: analisar a produção científica de enfermagem sobre a segurança do paciente na unidade de terapia intensiva. Método: revisão integrativa realizada nas bases de dados CINAHL, LILACS e SCOPUS, utilizando os descritores: patient safety/segurança do paciente, intensive care unit/unidade de terapia intensiva and nursing/enfermagem. Resultados: foram incluídos 13 artigos, analisados a partir de seis categorias: << Segurança do paciente na prevenção de eventos adversos na enfermagem >>, << Segurança do paciente na administração segura de medicamentos >>, << Segurança do paciente na comunicação efetiva >>, << Segurança do paciente na padronização de procedimentos >>, << Segurança do paciente na prevenção de úlcera por pressão >> e << Segurança do paciente na prática da higienização das mãos >>. Conclusão: os estudos apontaram como contribuições a importância da padronização dos procedimentos e quanto a baixa evidência das publicações relacionadas à enfermagem.(AU)
Objective: to analyze the scientific production on nursing related to patient's safety in the intensive care unit. Method: an integrative review conducted in CINAHL LILACS and SCOPUS databases, using the keywords: patient safety/patient safety, intensive care unit/intensive care unit and nursing/nursing. Results: the study included 13 articles analyzed from six categories: << Patient's safety in the prevention of adverse events in nursing >>, << Patient's safety in the safe administration of medication >>, << Patient's Safety in effective communication >>, << patient's Safety in the standardization of procedures >>, << patient's safety in the prevention of pressure ulcers >> and << patient's safety in the practice of handwashing >>. Conclusion: the study showed how contributions the importance of standardization of procedures and the low evidence of publications related to nursing.(AU)
Objetivo: analizar la producción científica de la enfermería en la seguridad del paciente en la unidad de cuidados intensivos. Método: una revisión integradora realizada en las bases de datos CINAHL, LILACS y SCOPUS, usando las palabras clave: la seguridad del paciente/la seguridad del paciente, unidad de cuidados intensivos/unidad de cuidados intensivos y de enfermería/ enfermería. Resultados: el estudio incluyó 13 artículos analizados a partir de seis categorías: << La seguridad del paciente en la prevención de eventos adversos en ancianos >>, << La seguridad del paciente en la administración segura de medicamentos >>, << la seguridad del paciente en la comunicación efectiva >>, << seguridad del paciente en la normalización de los procedimientos >>, << la seguridad del paciente en la prevención de úlceras por presión >> y << la seguridad del paciente en la práctica de lavado de manos >>. Conclusión: el estudio mostró cómo las contribuciones de la importancia de la normalización de los procedimientos y la escasa evidencia de publicaciones relacionadas con la enfermería.(AU)