Molecular characterization of vancomycin-resistant Enterococci strains eight years apart from its first isolation in São Paulo, Brazil.

E. faecium was the first reported VRE species, carrying the vanA gene in Brazil. In spite of this, vancomycin-resistant E. faecalis has become the predominant species in Brazilian hospitals. The aim of this study was to evaluate the genetic relatedness of VREs isolated in a Brazilian teaching hospital eight years apart from its first isolation. We analyzed 38 VRE strains obtained from 81 surveillance cultures of patients admitted to the four largest intensive care units in Hospital São Paulo in February, 2006. Presence of the vanA gene was assayed by PCR and PFGE analysis was used for molecular characterization. All VRE strains carried the vanA gene. Two distinct clonal groups were observed among vancomycin-resistant E. faecalis. Vancomycin-resistant E. faecium belonged to five distinct clones were demonstrated by molecular typing. All of these clones were different from the first vancomycin-resistant enterococci clone isolated eight years ago in our hospital.

Assessment of healthcare professionals' adherence to hand hygiene after alcohol-based hand rub introduction at an intensive care unit in São Paulo, Brazil.

We analyzed the impact of introducing an alcohol-based hand gel and an educational program on hand hygiene adherence among healthcare workers in an intensive care unit. Adherence to hand hygiene was significantly higher after the intervention for the night shift work period (P=.001), among nursing assistants (P=.001), among nurses (P=.007) on weekend days (P=.016), and for invasive procedures (P=.012).

Compliance with handwashing at two intensive care units in São Paulo.

Handwashing compliance was compared at two medical- surgical intensive care units (ICUs) of a teaching and a non-teaching hospital. The mean compliance was 22.2% and 42.6%, respectively. Respiratory therapists at the non-teaching hospital had the best handwashing compliance (52.6%). Nursing assistants at the teaching hospital had the worst compliance (11.5%). Nursing assistant was the only health-care worker category with a significant difference between the two ICUs (odds ratio = 6.0; 95% confidence interval = 3.83-9.43; p< 0.001).

The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report.

We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: risk factors and mortality.

OBJECTIVES: The aim of this study was to evaluate the risk factors and attributable mortality associated with imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in a medical-surgical intensive care unit (ICU). METHODS: A retrospective case-control study was carried out at a 16-bed medical-surgical ICU in a 780-bed, university-affiliated hospital. All patients admitted from January 1, 2003, to December 31, 2004, who had nosocomial infection caused by IRPA, were included in the study. RESULTS: Imipenem-resistant P. aeruginosa was recovered from 63 patients during the study period. One hundred eighty-two controls were matched with cases by period of admission, age, and time at risk. Urinary tract (34.9%) and respiratory tract (22.2%) were the main sources of IRPA isolation. In multivariate analysis, a previous stay in the ICU (odds ratio, 3.54; 95% confidence interval [CI], 1.29-9.73; P = .03) was the only independent risk factor for IRPA infection. The in-hospital mortality rate among case patients was 49% (31 of 63) compared with 33% (61 of 182) for control patients (odds ratio, 1.92; 95% CI, 1.07-3.44; P = .02). Thus, we had an attributable mortality of 16% (95% CI, 9.74%-22.3%; P = .03). CONCLUSIONS: Our study suggests that IRPA infections are strongly related to previous ICU stay, and that IRPA infections significantly increase mortality in those critical patients.

Impact of an education program on the incidence of central line-associated bloodstream infection in 2 medical-surgical intensive care units in Brazil.

An intervention study was undertaken to evaluate the impact of an education program on the incidence of central line-associated bloodstream infection (CLABSI) in 2 intensive care units. There was a nonsignificant reduction in the incidence of CLABSI (odds ratio, 0.46 [95% confidence interval, 0.21-1.02]; P=.04) despite a significant increase in knowledge of CLABSI prevention by the staff of both intensive care units after the education program.

Impact of a hospital-wide antimicrobial formulary intervention on the incidence of multidrug-resistant gram-negative bacteria.

We examined the impact of an antimicrobial formulary change, based on reduction in third-generation cephalosporin use, on resistant gram-negative pathogens in a tertiary hospital. No significant changes were demonstrated in their incidence per 1000 patient-days. Otherwise, there was a significant decrease in rate of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (63.1% to 52.5%, P = .04) and third-generation cephalosporin-resistant Enterobacter species (31.4% to 25%, P = .04) between the 2 study periods. On the other hand, there was also a significant increase in rate of ampicillin-sulbactam-resistant Acinetobacter baumannii (8% to 47%, P = .01) after the implementation of the formulary intervention.

Molecular characterization of vancomycin-resistant Enterococci strains eight years apart from its first isolation in São Paulo, Brazil / Caracterização molecular de espécies de Enterococci resistentes à vancomicina oito anos após seu primeiro isolamento em São Paulo, Brasil

E. faecium was the first reported VRE species, carrying the vanA gene in Brazil. In spite of this, vancomycin-resistant E. faecalis has become the predominant species in Brazilian hospitals. The aim of this study was to evaluate the genetic relatedness of VREs isolated in a Brazilian teaching hospital eight years apart from its first isolation. We analyzed 38 VRE strains obtained from 81 surveillance cultures of patients admitted to the four largest intensive care units in Hospital São Paulo in February, 2006. Presence of the vanA gene was assayed by PCR and PFGE analysis was used for molecular characterization. All VRE strains carried the vanA gene. Two distinct clonal groups were observed among vancomycin-resistant E. faecalis. Vancomycin-resistant E. faecium belonged to five distinct clones were demonstrated by molecular typing. All of these clones were different from the first vancomycin-resistant enterococci clone isolated eight years ago in our hospital.

E. faecium contendo o gene vanA foi a primeira espécie de VRE descrita, no Brasil. Apesar disto, E. faecalis resistente a vancomicina tem se tornado a espécie predominante nos hospitais brasileiros.O objetivo desse estudo foi avaliar a relação genética de VREs isolados em um hospital de ensino brasileiro após oito anos de seu primeiro isolamento. Analisamos 37 isolados de VRE obtidos de 81 culturas de vigilância de pacientes admitidos nas quatro maiores Unidades de Tratamento Intensivo em Fevereiro de 2006. A presença do gene vanA foi analisada por PCR e a caracterização molecular por PFGE. Todas as amostras VRE carreavam o gene vanA. Entre os E. faecalis vancomicina-resistentes, dois distintos grupos clonais foram observados. E. faecium resistente a vancomicina pertencentes a cinco clones distintos foram demonstrados por tipagem molecular. Todos esses clones foram diferentes do primeiro clone de enterococo resistente a vancomicina isolado oito anos atrás em nosso hospital.

Compliance with handwashing at two intensive care units in São Paulo

Handwashing compliance was compared at two medical- surgical intensive care units (ICUs) of a teaching and a non-teaching hospital. The mean compliance was 22.2 percent and 42.6 percent, respectively. Respiratory therapists at the non-teaching hospital had the best handwashing compliance (52.6 percent). Nursing assistants at the teaching hospital had the worst compliance (11.5 percent). Nursing assistant was the only health-care worker category with a significant difference between the two ICUs (odds ratio = 6.0; 95 percent confidence interval = 3.83-9.43; p< 0.001).