RESUMO
BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) is an increasing problem in healthcare settings. This study aimed to identify the source of a CPE outbreak that occurred in 2022, in a tertiary hospital in the North of Portugal, to identify exposed patients, and to assess the risk of becoming CPE-positive following hospital admission. METHODS: A multi-disciplinary investigation was conducted including descriptive, analytical, and molecular epidemiology, environmental screening, and assessment of infection control measures. Clinical and environmental isolates were analyzed using whole-genome sequencing and phylogenetic analysis. Additionally, a prospective observational cohort study was conducted to further investigate the risk factors associated with the emergence of new cases in cohorts of CPE-negative admitted patients. RESULTS: We observed the presence of multispecies KPC-, IMP-, and/or NDM-producing isolates. Genetically indistinguishable clinical and environmental isolates were found on the same room/ward. The ST45 KPC-3-producing Klebsiella pneumoniae clone was the responsible for the outbreak. During patients' treatment, we detected the emergence of resistance to ceftazidime-avibactam, associated with mutations in the blaKPC-3 gene (blaKPC-46, blaKPC-66 and blaKPC-124, the last variant never previously reported), suggesting a vertical evolutionary trajectory. Patients aged ≥ 75 years, hygiene/feeding-care dependent, and/or subjected to secretion aspiration were risk factors for CPE colonization after hospital admission. Additionally, cases with previous admission to the emergency department suggest that CPE dissemination may occur not only during hospitalization but also in the emergency department. CONCLUSION: Overall, the study highlights that selection pressure with antibiotics, like ceftazidime-avibactam, is a contributing factor to the emergence of new ß-lactamase variants and antibiotic resistance. It also shows that the hospital environment can be a significant source of CPE transmission, and that routine use of infection control measures and real-time molecular epidemiology investigations are essential to ensure the long-term termination of CPE outbreaks and prevent future resurgences.
Assuntos
Infecções por Klebsiella , Humanos , Portugal/epidemiologia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Filogenia , Estudos Prospectivos , beta-Lactamases/genética , beta-Lactamases/uso terapêutico , Proteínas de Bactérias/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Surtos de Doenças , Genômica , Hospitais , Klebsiella pneumoniae , Testes de Sensibilidade MicrobianaRESUMO
Objetivo: Verificar a eficácia de oficinaseducativas no conhecimento de Agentes Comunitários de Saúde sobre prevenção do pé diabético. Métodos: Estudo de intervenção educativa, do tipo antes e depois, realizado em 25 Unidades Básicas de Saúde nos municípios do interior no estado do Ceará,participaram 53 Agentes Comunitários de Saúde no período de setembro de 2020 a novembro de 2021, osencontros foram realizados mensalmente por um período de três meses,com a duração de até duas horas por encontro. Os temas utilizados nas oficinas foram: Vamos entender sobre o diabetes; O que é o pé diabético?A importância do Agente Comunitário de Saúde na prevenção do pé diabético. A avaliação do conhecimento foi por meio da aplicação de um questionário semiestruturado como pré e pós teste.Resultados:Identificou-se que 81,1% do grupo pesquisado nunca havia sido capacitado sobre a temáticaou palestra sobre a temática e destaca-se quehouve melhorias significativas em relação à compreensão acerca dascomplicações associadas ao diabetes mellitus(84,9%-100%) e a importância do exame do pé das pessoas com diabetes mellitus (30,2%-100%).Conclusão: As capacitações contribuíram para promover novas informações acerca da temática aos ACS que foi representado pelo aumento na média de acertos em comparação entre pré e pós teste.
Objective: To verify the effectiveness of educational workshops in the knowledge of Community Health Agents on the prevention of diabetic foot. Methods:Before and after educational intervention study, carried out in 25 Basic Health Units in the countryside of the state of Ceará, 53 Community Health Agents participated in the period from September 2020 to November 2021, meetings were held monthly for a period of three months, lasting up to two hours per meeting. The themes used in the workshops were: Let's understand about diabetes; What is the diabetic foot?The importance of the Community Health Agent in the prevention of diabetic foot. The assessment of knowledge was through the application of a semi-structured questionnaire as a pre and post test. Results: It was identified that 81.1% of the researched group had never been trained on the subject or lecture on the subject and it is noteworthy that there were significant improvements in terms of understanding about the complications associated with diabetes mellitus (84.9%-100%) and the importance of examining the foot of people with diabetes mellitus (30.2%-100%). Conclusion:The training contributed to promoting new information on the subject to the ACS, which was represented by the increase in the average of correct answers compared to between pre and post test.
Objetivo: Verificar la efectividad de los talleres educativos en el conocimiento de los Agentes Comunitarios de Salud sobre la prevención del pie diabético. Métodos: Estudio de intervención educativa antes y después, realizado en 25 Unidades Básicas de Salud del interior del estado de Ceará, participaron 53 Agentes Comunitarios de Salud en el período de septiembre de 2020 a noviembre de 2021, las reuniones se realizaron mensualmente durante un período de tres meses. , con una duración de hasta dos horas por reunión. Los temas utilizados en los talleres fueron: Entendamos sobre la diabetes; ¿Qué es el pie diabético?La importancia del Agente de Salud Comunitario en la prevención del pie diabético. La evaluación de los conocimientos fue mediante la aplicación de un cuestionario semiestructurado como pre y post test. Resultados:Se identificó que el 81,1% del grupo investigado nunca había sido capacitado en el tema o disertado sobre el tema y se destaca que hubo mejoras significativas en cuanto a la comprensión sobre las complicaciones asociadas a la diabetes mellitus (84,9%-100% ) y la importancia de examinar el pie de las personas con diabetes mellitus (30,2%-100%).Conclusión:La capacitación contribuyó a promover nueva información sobre el tema para la ACS, lo que estuvo representado por el aumento en el promedio de respuestascorrectas en comparación entre el pre y el post test.