Gérmenes aislados en pacientes ingresados en la terapia intensiva del Hospital Clínico Quirúrgico Provincial Dr. Joaquín Albarrán / Germs isolated from intensive care patients at Dr. Joaquín Albarrán Provincial Clinical Surgical Hospital

Introducción: Las infecciones asociadas a los cuidados sanitarios en los servicios de atención al paciente crítico se asocian a un alto riesgo de muerte y costos significativos. Objetivo: Identificar los gérmenes más frecuentes en los cultivos y su resistencia a los antimicrobianos en la terapia intensiva del Hospital Clínico Quirúrgico Provincial Dr. Joaquín Albarrán. Métodos: Se realizó un estudio descriptivo, retrospectivo, en la terapia intensiva del Hospital Clínico Quirúrgico Provincial Dr. Joaquín Albarrán, de enero del 2015 a diciembre del 2018, el universo estuvo constituido por 1847 cultivos realizados seleccionándose 654 en los que se obtuvo crecimiento; para el análisis estadístico se utilizó el SPSS 22.0. Resultados: De los gérmenes aislados, la Klebsiella spp fue la más frecuente (31 por ciento), seguida del Staphylococcus spp (24,5 por ciento) y de la E. coli (9,8 por ciento). En los esputos se mantuvo la Klebsiella spp (45,1 por ciento), en los hemocultivos el Staphylococcus spp (53,6 por ciento) y en los urocultivos la Candida (41,1 por ciento), seguida de la E. coli (27 por ciento). De los antimicrobianos usados en terapia para tratar la Klebsiella spp, la E. coli, el Acinetobacter y la pseudomona spp, el más recomendado es la colistina (0-25 por ciento de resistencia) y para el Staphylococcus spp, la vancomicina (1,8 por ciento). Conclusiones: Los gérmenes Gram negativos siguen siendo los más frecuentemente aislados en los cultivos de los pacientes hospitalizados en terapia, con un alto nivel de resistencia para la mayoría de los antibióticos(AU)

Introduction: Infections related to critical care settings are associated to high death risk and significant costs. Objective: Identify the germs most commonly found in cultures and their resistance to antimicrobials in the intensive care service of Dr. Joaquín Albarrán Provincial Clinical Surgical Hospital. Methods: A retrospective descriptive study was conducted at the intensive care service of Dr. Joaquín Albarrán Provincial Clinical Surgical Hospital from January 2015 to December 2018. The study universe was 1 847 cultures, from which 654 were selected in which growth was obtained. Data were processed with the statistical software SPPS 22.0. Results: Of the germs isolated, Klebsiella spp. were the most common (31 percent, followed by Staphylococcus spp. (24.5 percent) and E. coli (9.8 percent). Klebsiella spp. were frequent in sputum cultures (45.1 percent), Staphylococcus spp. in blood cultures (53.6 percent) and Candida in urine cultures (41.1 percent), followed by E. coli (27 percent). Among the antimicrobials used to treat Klebsiella spp., E. coli, Acinetobacter and Pseudomonas spp., the most recommended is colistin (0-25 percent resistance) and vancomycin for Staphylococcus spp. (1.8 percent). Conclusions: Gram-negative germs continue to be the most commonly isolated in cultures from intensive care patients, with a high level of resistance to most antibiotics(AU)

Normas 2017 de contención de infecciones por gérmenes productores de carbapenemasas del Hospital Nacional de Itauguá, Paraguay / 2017 regulations for the containment of carbapenemase-producing infections of the National Hospital of Itauguá, Paraguay

La carbapenemasa es una enzima producida por varias especies bacterianas, capaz de inactivar un grupo de antibióticos: los carbapenemes. El riesgo radica, además de la dificultad para el tratamiento de las infecciones resistentes a estos antibióticos, en su fácil diseminación entre especies bacterianas, entre pacientes y entre pacientes y contactos (familiares, personal de salud, etc.) Su sigla KPC se generalizó desde el primer caso se dio en la Klebsiella pneumoniae. Se publican Normas que tienen el objetivo de prevenir y controlar la colonización e infección de pacientes con gérmenes productores de carbapenemasa (tipo KPC-NDM etc.) en el Hospital Nacional.

Carbapenemase is an enzyme produced by several bacterial species, capable of inactivating a group of antibiotics: carbapenems. In addition to the difficulty in treating infections resistant to these antibiotics, the risk lies in their easy spread among bacterial species, between patients and between patients and contacts (family members, health personnel, etc.). Its initials KPC was generalized since the first case that occurred in Klebsiella pneumoniae. Guidelines that aim to prevent and control the colonization and infection of patients with carbape

Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12 percent chlorhexidine gluconate

In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12 percent chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4 percent) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47 percent), Candida albicans (35.3 percent), Klebsiella pneumoniae (5.9 percent), enteropathogenic Escherichia coli (5.9 percent), and Stenotrophomonas maltophilia (5.9 percent). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80 percent) when compared with patients with normal oral mucosa (33.3 percent). In conclusion, the results of the present study suggest that the prophylactic use of 0.12 percent chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition, the present findings suggest a possible relationship between coagulase-negative staphylococci and the development of oral mucositis.

Tendo em vista o potencial de morbidade das complicações orais em pacientes com leucemia, este estudo avaliou as alterações clínicas e microbiológicas que ocorrem na mucosa bucal de crianças com leucemia linfoblástica aguda (LLA), submetidas à quimioterapia antineoplásica e administração profilática do gluconato de clorexidina 0,12 por cento. A amostra foi constituída de 17 crianças de 2 a 12 anos, as quais foram submetidas a exame clínico da mucosa oral para a detecção de lesões bucais. Além disso, foi coletado material biológico das mucosas labial e jugal para análises microbiológicas. A mucosite oral foi observada em apenas 5 (29,4 por cento) pacientes. A análise microbiológica revelou a presença de um número reduzido de microorganismos potencialmente patogênicos, como estafilococos coagulase-negativos (47 por cento), Candida albicans (35,3 por cento), Klebsiella pneumoniae (5,9 por cento), Escherichia coli enteropatogênica (5,9 por cento) e Stenotrophomonas maltophilia (5,9 por cento). Pacientes com mucosite oral apresentaram uma maior freqüência de estafilococos coagulase-negativos (80 por cento) quando comparados aos pacientes que exibiam mucosa oral normal (33,3 por cento). Em conclusão, os resultados do presente estudo sugerem que o uso profilático do gluconato de clorexidina 0,12 por cento reduz a freqüência de mucosite oral e de patógenos orais em crianças com LLA. Além disso, os presentes achados sugerem uma possível relação entre estafilococos coagulase-negativos e o desenvolvimento de mucosite oral.

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker

OBJETIVO: Descrever surto por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em berçário de risco intermediário. MÉTODOS: Após identificação dos primeiros casos, a situação foi conduzida como surto, sendo intensificadas as medidas básicas de prevenção de infecções hospitalares e investigadas possíveis fontes de disseminação da bactéria. RESULTADOS: O surto durou 6 meses e atingiu 36 recém-nascidos, causando sete infecções e 29 colonizações. Na primeira fase do surto, os portadores evoluíram com infecção, porém, na segunda fase, os portadores eram assintomáticos e só foram identificados por culturas de vigilância. O surto foi resolvido após identificação e tratamento de profissional de saúde que apresentava onicomicose e era portadora de Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido nas mãos. CONCLUSÃO: Detecção e controle da disseminação oculta da bactéria multirresistente entre os recém-nascidos de menor risco evitou sua instalação endêmica no berçário, bem como a conseqüente exposição dos pacientes mais graves e suscetíveis à infecção.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSION: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Klebsiella pneumoniae outbreak in a cancer unit of a general hospital: predisposing factors and evaluation of the impact of intervention measures

We made a retrospective cohort study of a primary bloodstream infection outbreak in patients of a cancer unit in a general hospital, evaluated the impact of intervention measures and investigated the predisposing factors. The targeted predisposing factors were selected based on the medical literature. The data were treated with univariate analysis to calculate the relative risk, and statistical significance was set at p<0.05. The presence of a long-term totally-implanted central venous catheter appears to be a predisposing factor, while a peripheral venous catheter appears to have offered protection from infection. This is reinforced by fact that intervention measures controlled the outbreak, suggesting cross-contamination from a common source. These findings corroborate the fundamental role of the hospital infection control service in early intervention and reinforce the need for continued training of health professionals that perform this type of care.

Risk factors for neonatal Klebsiella septicemia in Srinagarind Hospital.

Three years' data were analysed to assess the risk factors for neonatal Klebsiella septicemia in Srinagarind Hospital. The incidence of Klebsiella septicemia was 4.1 per 1,000 livebirths or 5.2 per 100 discharged infants. Eighty-two per cent of infected cases were low birth weight infants and 67.7% were born prematurely. From multivariate analysis, the risk factors were endotracheal intubation (OR 31.57, 95% CI 289-343.82) and central venous catheterization (OR 16.99, 95% CI1.15-250.37). The overall mortality rate was 67.7%. Periodic review and continuous reinforcement of infection control policies in the neonatal unit are of paramount importance to decrease the incidence of nosocomial infection and successful control of outbreaks as well.

Asymptomatic bacteriuria in school children.

We studied 2447 asymptomatic school children by microscopic examination of urine and culture of a clear voided midstream specimen of urine. Only three children had bacteriuria (0.12%). Urographic abnormalities were detected in both the cases, which could be investigated. This study has shown that asymptomatic bacteriuria is comparatively rare in our community; however where there is bacteriuria, renal damage is common.