Congenital diaphragmatic hernia in a middle-income country: Persistent high lethality during a 12-year period.

BACKGROUND: In high- and middle-income countries, mortality associated to congenital diaphragmatic hernia (CDH) is high and variable. In Brazil, data is scarce regarding the prevalence, mortality, and lethality of CDH. This study aimed to analyze, in São Paulo state of Brazil, the temporal trends of prevalence, neonatal mortality and lethality of CDH and identify the time to CDH-associated neonatal death. METHODS: Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥400g, from mothers residing in São Paulo State, Brazil, during 2004-2015. CDH definition and its subgroups classification were based on ICD-10 codes reported in the death and/or live birth certificates. CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. CDH prevalence, neonatal mortality and lethality were calculated and their annual percent change (APC) with 95% confidence intervals (95%CI) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that CDH-associated neonatal death occurred. RESULTS: CDH prevalence was 1.67 per 10,000 live births, with a significant increase throughout the period (APC 2.55; 95%CI 1.30 to 3.83). CDH neonatal mortality also increased over the time (APC 2.09; 95%CI 0.27 to 3.94), while the lethality was 78.78% and remained stationary. For isolated CDH, CDH associated to non-chromosomal anomalies and CDH associated to chromosomal anomalies the lethality was, respectively, 72.25%, 91.06% and 97.96%, during the study period. For CDH as a whole and for all subgroups, 50% of deaths occurred within the first day after birth. CONCLUSIONS: During a 12-year period in São Paulo State, Brazil, CDH prevalence and neonatal mortality showed a significant increase, while lethality remained stable, yet very high, compared to rates reported in high income countries.

Pseudomonas aeruginosa clonal dissemination in Brazilian intensive care units.

OBJECTIVE: Investigate clonal dissemination of nosocomial multidrug-resistant Pseudomonas aeruginosa isolates within and between Brazilian intensive care units, which participated in the MYSTIC Program Brazil 2002. METHODS: Thirty-six P. aeruginosa isolates resistant to meropenem or imipenem plus at least two of the following drugs: ciprofloxacin, cefepime, ceftazidime or piperacillin/tazobactam were isolated during 2002 at 4 centres in São Paulo and 1 centre in Brasília. Chromosomal restriction fragments obtained with SpeI were separated by pulsed-field gel electrophoresis (PFGE). Electrophoretic patterns were analyzed with GelCompar II v. 2.5. RESULTS: Five major clones were identified (A, B, C, D, G). Clone A was constituted by 8 isolates with indistinguishable PFGE pattern present in 2 centres. Clone B was constituted by 4 indistinguishable isolates predominant in centre 6. Clone C had 3 indistinguishable isolates, with closely related clones (C1-3). Also, Clone D had 3 indistinguishable isolates, with closely related (D1) and possibly related (D2/D3) clones. Clones C and D were present in centre 1. Clone G was constituted by 2 indistinguishable isolates and was present in centre 7. Finally, 8 isolates were unique. Isolates from Centre 4 were unique. CONCLUSIONS: Clonal dissemination was detected within (clones A, B, C, D, and G) and between centres (clone A). These findings are important when analyzing surveillance data, since susceptibility rates may be significantly affected by the dissemination of a resistant clone.

Diseminación clonal de Pseudomonas aeruginosa en unidades de cuidados intensivos brasileñas / Pseudomonas aeruginosa clonal dissemination in Brazilian intensive care units

Objetivo. Investigar la diseminación clonal de cepas nosocomiales multirresistentes de Pseudomonas aeruginosa en y entre unidades de cuidados intensivos brasileñas participantes en el MYSTIC Program Brazil 2002.Métodos. Durante 2002, se aislaron en cuatro hospitales de São Paulo y en un hospital de Brasilia 36 cepas de P. aeruginosa resistentes a meropenem o imipenem y a al menos dos de los siguientes: ciprofloxacino, cefepima, ceftazidima o piperacilina/tazobactam. Los fragmentos de restricción cromosómica obtenidos mediante Spel se separaron con electroforesis en campo pulsado (PFGE) y se analizaron mediante GelCompar II v.2.5. Resultados. Se identificaron cinco clones principales (A, B, C, D y G). El clon A constaba de ocho cepas con un patrón PFGE indistinguible, aisladas en dos centros. El clon B estaba formado por cuatro cepas indistinguibles, predominantes en el centro 6. El clon C estaba formado por tres cepas indistinguibles con clones estrechamente relacionados (C1-3). Además, el clon D estaba formado por tres cepas indistinguibles con clones estrechamente (D1) o posiblemente relacionados (D2/D3). Los clones C y D se detectaron en el centro 1. El clon G estaba formado por dos cepas indistinguibles y se observó en el centro 7. Finalmente, ocho cepas fueron específicas. Las cepas del centro 4 fueron específicas. Conclusiones. Se detectó diseminación clonal en los propios centros (clones A, B, C, D y G) y entre centros (clon A). Estos hallazgos son importantes para evaluar los datos de vigilancia epidemiológica pues la diseminación de un clon resistente puede influir de manera significativa en las tasas de sensibilidad (AU)

Objective. Investigate clonal dissemination of nosocomial multidrug-resistant Pseudomonas aeruginosa isolates within and between Brazilian intensive care units, which participated in the MYSTIC Program Brazil 2002. Methods. Thirty-six P. aeruginosa isolates resistant to meropenem or imipenem plus at least two of the following drugs: ciprofloxacin, cefepime, ceftazidime or piperacillin/tazobactam were isolated during 2002 at 4 centres in São Paulo and 1 centre in Brasília. Chromosomal restriction fragments obtained with SpeI were separated by pulsed-field gel electrophoresis (PFGE). Electrophoretic patterns were analyzed with GelCompar II v. 2.5.Results. Five major clones were identified (A, B, C, D, G). Clone A was constituted by 8 isolates with indistinguishable PFGE pattern present in 2 centres. Clone B was constituted by 4 indistinguishable isolates predominant in centre 6. Clone C had 3 indistinguishable isolates, with closely related clones (C1-3). Also, Clone D had 3 indistinguishable isolates, with closely related (D1) and possibly related (D2/D3) clones. Clones C and D were present in centre 1. Clone G was constituted by 2 indistinguishable isolates and was present in centre 7. Finally, 8 isolates were unique. Isolates from Centre 4 were unique. Conclusions. Clonal dissemination was detected within (clones A, B, C, D, and G) and between centres (clone A). These findings are important when analyzing surveillance data, since susceptibility rates may be significantly affected by the dissemination of a resistant clone (AU)