RESUMO
OBJECTIVES: Highly active antiretroviral therapy (HAART) has dramatically changed the natural history of HIV infection in children, but there are few studies in the literature about the incidence of clinical manifestations after HAART in this population, compared with adults. The aim of this study was to describe the influence of the widespread use of HAART on the development of opportunistic infections and organ-specific diseases in HIV-infected children. METHODS: An observational study of a cohort of 366 vertically HIV-infected children followed from 1990 to 2006 was carried out. According to the main antiretroviral protocol used, three calendar periods (CPs) were defined and compared: CP1 (1990-1996: no patients on HAART), CP2 (1997-1999: <60% on HAART) and CP3 (2000-2006: >60% on HAART). RESULTS: Children experienced a progressive increase in CD4 T cell count (P<0.05) and a decrease in HIV viral load from 1996 onwards (P<0.05). Similarly, rates of death, AIDS, opportunistic infections (bacteraemia, candidosis, cryptosporidiosis and bacterial pneumonia) and organ-specific diseases (wasting syndrome, thrombocytopenia, cardiomyopathy, lymphoid interstitial pneumonia and HIV-associated encephalopathy) were lower in CP2 and CP3 than in CP1. CONCLUSIONS: This study provides evidence of improved clinical outcomes in HIV-infected children over time and shows that mortality, AIDS, opportunistic infections and organ-specific diseases declined as HAART was progressively instituted in this population.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , HIV-1 , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por HIV/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Espanha/epidemiologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Carga ViralRESUMO
Clinical variables associated with the isolation of Klebsiella pneumoniae expressing different extended-spectrum beta-lactamases (ESBLs) were studied. Clinical records of patients with ESBL-positive K. pneumoniae isolates between 1989 and 2003 (n = 80) were reviewed retrospectively. Patients with SHV- and TEM-type ESBLs were identified more frequently in the intensive care units (67% and 78%, respectively), whereas those with CTX-M ESBLs were found in medical wards (52.2%) or were outpatients (17.4%) (p <0.01). The absence of urinary or central catheters was associated with CTX-M-10 (p 0.013 and p <0.01, respectively). Central catheter-related infections and secondary bacteraemia were associated more frequently with SHV- and TEM-type ESBLs, whereas urinary tract infections were associated with CTX-M-10. Previous aminoglycoside use was associated particularly with SHV-type ESBLs (p <0.01), whereas amoxycillin-clavulanate and oral cephalosporins were associated with CTX-M-10 (p <0.01 and p 0.050, respectively). The frequency of adequate empirical treatment was low (22%), and 61% of patients were treated according to the susceptibility testing results. Mortality (22%) and related mortality (14%) did not differ statistically according to the type of ESBL. Different ESBL types in K. pneumoniae were associated with different clinical variables, and this should be taken into account in current and future epidemiological scenarios.
Assuntos
Infecção Hospitalar/microbiologia , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Resistência beta-Lactâmica , beta-Lactamases/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/mortalidade , Feminino , Hospitais de Ensino , Humanos , Lactente , Controle de Infecções , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Published evidence suggests that some of the benefits of modern dressings--longer wear times and less frequent dressing changes--make them more cost-effective than traditional gauze dressings in pressure ulcer management.
Assuntos
Bandagens/economia , Úlcera por Pressão/economia , Higiene da Pele/economia , Bandagens/tendências , Doença Crônica , Redução de Custos , Análise Custo-Benefício , Medicina Baseada em Evidências , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Modelos Econométricos , Pesquisa em Administração de Enfermagem , Pesquisa em Avaliação de Enfermagem , Úlcera por Pressão/terapia , Projetos de Pesquisa , Higiene da Pele/instrumentação , Higiene da Pele/enfermagem , Higiene da Pele/tendências , Estudos de Tempo e Movimento , Carga de Trabalho , CicatrizaçãoRESUMO
This article reports the contamination of a batch of liquid soap for hospital use with Raoultella planticola. The micro-organism was first identified as Klebsiella pneumoniae due to the inability of automated systems to characterize this species. There is a need to strengthen the inspection of cosmetic products to be used in the hospital setting. It is recommended that hospitalized patients at the highest risk of infection should use antimicrobial soaps for personal hygiene. The incidence of infections due to R. planticola is unknown as it is usually misclassified as Klebsiella spp. by automated systems.
Assuntos
Enterobacteriaceae/isolamento & purificação , Microbiologia Ambiental , Sabões , Cosméticos , Enterobacteriaceae/classificação , Hospitais , Humanos , Controle de Infecções/métodosRESUMO
The Karolinska Burn Unit in Stockholm, Sweden, carried out a retrospective case review in order to compare the cost of the current protocol of care - in place since mid-2002 - with a previous protocol in paediatric burn patients. The study compared the years 2004 and 2007 with the year 2001. 2004 was the first full year in which the unit staff used Acticoat(TM) (Smith & Nephew Wound Management, Hull, England), IntraSite Gel(TM) (idem), and Allevyn Adhesive(TM) (idem) in the treatment of paediatric burns patients. In 2001 the unit used Mepitel(TM) (Molnlycke, Göteborg, Sweden) together with a saline solution and peroxide for cleansing. This study examined differences in both labour and material costs, measured from the hospital's perspective. Our results show that the main impact of the new protocol was on length of stay for hospitalized patients. In 2001 the mean in-patient stay was 12.5 days; in 2004 the mean stay was 5.6 days and, in 2007, 4.5 days (p < 0.001). It is hypothesized that the reason for this significant reduction in length of stay is that most of the patients treated with Acticoat were sent home earlier to be treated as outpatients because there was less need for sedation and/or analgesics, and because the risk of infection was perceived to be less. Pure hospitalization costs per in-patient were approximately Swedish kronor (kr) 67,725 in 2001 (1 kr = approx. 0.1 or US$ 0.15) and kr 30,305 and kr 24,440 in 2004 and 2007, respectively. This represents a saving of 55% and 64% with respect to 2001 costs.
RESUMO
BACKGROUND: Bacteraemia is a major complication associated with the use of long-term intravascular catheters. Conservative treatment using antibiotic-lock therapy (ALT) has been shown to be useful in some studies, but the evidence supporting its impact in clinical care is still scarce. METHODS: We evaluated the outcome of the episodes of catheter-related bacteraemia (CRB) associated with long-term intravascular devices used for chemotherapy or parenteral nutrition and that were managed with ALT during a 44 month period in our hospital. Episodes of CRB associated with catheters implanted in the same department during the same period, and that were managed with only systemic antibiotics were used as a control group. Antibiotic-lock solution consisted of a heparin solution of 20 IU/mL including vancomycin (for Gram-positive microorganisms) or ciprofloxacin or gentamicin (for Gram-negative bacilli), all at a concentration of 2 mg/mL. ALT was used for a minimum of 8-12 h/day, during 5-14 days. Effectiveness was assessed by clinical and microbiological criteria. RESULTS: A total of 801 long-term intravascular devices were placed in 105 patients during this period. There were 127 episodes of bacteraemia documented in these patients, with 92 being CRB. Of these, 48 episodes fulfilled inclusion criteria for the analysis. Nineteen episodes were treated with ALT plus systemic antibiotics, and 29 episodes were treated only with systemic antibiotics. Isolated microorganisms were similar in the two groups. The catheter had to be removed during therapy in one episode in the antibiotic-lock group and in seven episodes in the control group. Relapse of the bacteraemia with the same microorganism after stopping therapy was observed in two and three patients in the study group and the control group, respectively. Overall, successful treatment was achieved in 84% and 65% of the episodes in the antibiotic-lock group and the control group, respectively (P = 0.27). CONCLUSIONS: ALT appears as an effective conservative treatment in the management of CRB associated with long-term intravascular devices (84% in the present series), especially in infections caused by coagulase-negative staphylococci.
Assuntos
Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Bacteriemia/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Ciprofloxacina/uso terapêutico , Gentamicinas/uso terapêutico , Heparina/uso terapêutico , Vancomicina/uso terapêutico , Bacteriemia/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Humanos , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS , Infecções por Bordetella , Bordetella bronchiseptica , Pneumonia Bacteriana , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Antibacterianos , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Bordetella bronchiseptica/efeitos dos fármacos , Bordetella bronchiseptica/isolamento & purificação , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologiaRESUMO
Streptococcus pneumoniae es responsable de una importante morbilidad y mortalidad, afectando especialmente a niños menores de 2 años, mayores de 65 años y adultos inmunocomprometidos o inmunocompetentes con patología de base. Actualmente sólo disponemos de una vacuna de 23 polisacáridos que, aunque eficaz en personas de edad avanzada, presenta importantes limitaciones: no es eficaz en niños menores de 2 años ni en inmunodeprimidos, induce una respuesta inmunológica variable, de poca duración y no confiere memoria inmunológica.Todo ello orientó la investigación hacia nuevas vacunas antineumocócicas conjugadas que inducen memoria inmunológica. Los ensayos clínicos realizados han demostrado su inmunogenicidad y seguridad en niños. Los resultados preliminares del estudio llevado a cabo con la vacuna conjugada heptavalente (PncCRM) demuestran una eficacia del 100 por ciento (IC95 por ciento : 81-100 por ciento) frente a serotipos vacunales, y 89 por ciento frente a todos los neumococos. Esta vacuna ha sido recientemente aprobada por la FDA para la prevención de meningitis y bacteriemia causada por S. pneumoniae en niños menores de 2 años y en aquellos entre 2 y 5 años con alto riesgo de padecer la enfermedad (AU)