Active surveillance of carbapenem-resistant Gram-negative healthcare-associated infections in a low-middle-income country city.

BACKGROUND: Carbapenem-resistance in healthcare-associated infections (HCAIs) is of great concern, and it is urgent to improve surveillance. We aimed to describe and analyze HCAIs trends on Gram-negative antimicrobial susceptibility in a city from a developing country, following the implementation of an active surveillance program. METHODS: This is an aggregated study describing data from 24 hospitals with intensive care units, including a trend analysis by Joinpoint regression between January 2012 and December 2017. RESULTS: There were 23,578 pathogens in 39,832 HCAIs, from which 16,225 were Gram-negatives (68.8%). Carbapenem susceptibility was lowest in A. baumannii (15.4-25.9%), K. pneumoniae (51.0-55.9%), and P. aeruginosa (64.9-84.1%) and highest in E. coli (96.5-99.2%). Only K. pneumoniae showed a significant Joinpoint at 95% confidence interval: -10.71% (-18.02; -2.75) from 2012 to 2014, p=0.02, and 6.54% (-2.00; 15.83) from 2015 to 2017, p=0.12, which was most influenced by urinary tract infections: -9.98% (-16.02; -3.48) from 2012 to 2014, p=0.01, and 9.66% (-1.75; 22.39) from 2015 to 2017, p=0.09. CONCLUSION: Although we found a significant change toward an improvement in carbapenem susceptibility in K. pneumoniae, resistance is high for most pathogens. These data should encourage health institutions to improve their prevention and control strategies.

Active surveillance of carbapenem-resistant Gram-negative healthcare-associated infections in a low-middle-income country city

ABSTRACT Background: Carbapenem-resistance in healthcare-associated infections (HCAIs) is of great concern, and it is urgent to improve surveillance. We aimed to describe and analyze HCAIs trends on Gram-negative antimicrobial susceptibility in a city from a developing country, following the implementation of an active surveillance program. Methods: This is an aggregated study describing data from 24 hospitals with intensive care units, including a trend analysis by Joinpoint regression between January 2012 and December 2017. Results: There were 23,578 pathogens in 39,832 HCAIs, from which 16,225 were Gram-negatives (68.8%). Carbapenem susceptibility was lowest in A. baumannii (15.4-25.9%), K. pneumoniae (51.0-55.9%), and P. aeruginosa (64.9-84.1%) and highest in E. coli (96.5-99.2%). Only K. pneumoniae showed a significant Joinpoint at 95% confidence interval: −10.71% (−18.02; −2.75) from 2012 to 2014, p = 0.02, and 6.54% (−2.00; 15.83) from 2015 to 2017, p = 0.12, which was most influenced by urinary tract infections: −9.98% (−16.02; −3.48) from 2012 to 2014, p = 0.01, and 9.66% (−1.75; 22.39) from 2015 to 2017, p = 0.09. Conclusion: Although we found a significant change toward an improvement in carbapenem susceptibility in K. pneumoniae, resistance is high for most pathogens. These data should encourage health institutions to improve their prevention and control strategies.

Desafios e atuação da Vigilância Sanitária no enfrentamento da Covid-19 no Estado do Paraná / Challenges and actions of the Health Surveillance in coping with Covid-19 in the State of Paraná

A pandemia da Covid-19 apresentou uma necessidade tempestiva de intensificação das medidas de prevenção e controle sanitário, o que pautou a Vigilância Sanitária e a trouxe como importante aliada às demais áreas para este enfrentamento. Este estudo apresenta um relato de experiência da atuação da Vigilância Sanitária do Paraná e dos desafios encontrados frente a Covid-19, mediante uma análise descritiva das ações desenvolvidas e dos dados registrados no sistema SIEVISA. Os resultados apontam uma atuação diversificada e interdisciplinar, por meio de elaboração de Notas Orientativas e Resoluções, e da execução de ações educativas e de fiscalização. No SIEVISA, foram registradas 7.535 ações relacionadas à Covid-19, executadas de forma descentralizada. Com isso constatou-se a necessidade de transpor obstáculos e de fomentar o uso do sistema SIEVISA. Por fim, a pandemia e a necessidade de enfrentá-la de forma coesa, concreta e coerente fortaleceram a importância do trabalho integrado e articulado em equipe. (AU)

The Covid-19 pandemic needs a timely and effective intensification for preventive and health control measures, so the Health Surveillance came into attention and has become an important ally articulated with other areas for this confronting. This study aims to present an experience report of the Paraná Health Surveillance performance and challenges encountered in the face of Covid-19, through a descriptive analysis of the actions developed and the data recorded in the SIEVISA system. The results showed a diverse and interdisciplinary work by the elaboration of Guidance Notes and Resolutions, the realization of guidelines and training, also the execution of educational and inspection actions. In SIEVISA, 7,535 actions related to Covid-19 were registered, carried out in a decentralized manner. For this, there was a need both to overcome problems, as well as to encourage the use of the SIEVISA system. Finally, the pandemic and the need to face it the cohesive, concrete and coherent way strengthened the importance of integrated and articulated teamwork. (AU)