Fatal sepsis caused by mecA-positive oxacillin-susceptible Staphylococcus aureus: First report in a tertiary hospital of southern Brazil.

mecA-positive oxacillin phenotypically susceptible Staphylococcus aureus (OS-MRSA) is increasingly reported worldwide. This bacterium poses a therapeutic threat, as it can be misidentified as an oxacillin-susceptible organism by phenotypic methods that are routinely used in the majority of clinical microbiology laboratories. Herein, we report the first case of fatal sepsis in a 43-year-old female patient caused by an OS-MRSA SCCmec type IVa/ST1/CC1 in a tertiary hospital in southern Brazil, which highlights the difficulties involved in diagnosing this bacterium. Blood cultures and phenotypic susceptibility tests on admission yielded a penicillin-resistant S. aureus. Although vancomycin therapy was initiated, this antibacterial was replaced by oxacillin, based on the susceptibility result. However, the clinical conditions of the patient deteriorated rapidly evolving to fatal septic shock. Clinical microbiology laboratories should consider the use of additional tests to accurately distinguish between various antimicrobial phenotypes of S. aureus.

Development of a melting-curve based multiplex real-time PCR assay for simultaneous detection of Streptococcus agalactiae and genes encoding resistance to macrolides and lincosamides.

BACKGROUND: Streptococcus agalactiae or Group B Streptococcus (GBS) remains the leading cause of infections in newborns worldwilde. Prenatal GBS screening of pregnant women for vaginal-rectal colonization is recommended in many countries to manage appropriate intrapartum antimicrobial prophylaxis for those identified as carriers. In this study, a novel melting-curve based multiplex real-time PCR assay for the simultaneous detection of GBS and macrolide and lincosamide resistance markers was developed. The usefulness of the assay was evaluated for rapid and accurate prenatal GBS screening. METHODS: One hundred two pregnant women who were at 35-37 weeks of gestation were enrolled in this study. The analytical performance of the multiplex real-time PCR was first tested using a panel of reference and clinical bacterial and fungal strains. To test the clinical performance, vaginal-rectal swabs were obtained from pregnant women who were seen at the teaching hospital for regular prenatal care. The results of real-time were compared with those obtained from microbiological analyses. RESULTS: The real-time PCR assay showed 100% specificity and a limit of detection of 104 colony forming units equivalent per reaction. The prevalence of GBS colonization among the population studied was 15.7% (16/102) based on a positive culture and the real-time PCR results. Agreement between the two assays was found for 11 (68.75%) GBS colonized women. Using the culture-based results as a reference, the multiplex real-time PCR had a sensitivity of 91.7% (11/12, CI 59.7-99.6%), a specificity of 95.5% (86/90, CI 89.8-98.7%), a positive predictive value of 73.3% (11/15, CI 44.8-91.1%) and a negative predictive value of 98.9% (86/87, CI 92.9-99.9%). CONCLUSION: The multiplex real-time PCR is a rapid, affordable and sensitive assay for direct detection of GBS in vaginal-rectal swabs.

Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization.

OBJECTIVE: To estimate the cost of hospitalization of patients with severe sepsis or septic shock admitted or diagnosed in the Urgent and Emergency sector at a university hospital and followed until the clinical outcome. METHOD: An epidemiological, prospective, observational study conducted in a public hospital in southern Brazil for the period of one year (August 2013 to August 2014). Sepsis notification forms, medical records and data of the cost sector were used for the collection of clinical and epidemiological data. RESULTS: The sample comprised 95 patients, resulting in a total high cost of hospitalization (R$ 3,692,421.00), and an average of R$ 38,867.60 per patient. Over half of the total value of the treatment of sepsis (R$ 2,215,773.50) was assigned to patients who progressed to death (59.0%). The higher costs were related to discharge, diagnosis of severe sepsis, the pulmonary focus of infection and the age group of up to 59 years. CONCLUSION: The high cost of the treatment of sepsis justifies investments in training actions and institution of protocols that can direct preventive actions, and optimize diagnosis and treatment in infected and septic patients. OBJETIVO: Estimar o custo da internação de pacientes com sepse grave ou choque séptico admitidos ou diagnosticados no setor de Urgências e Emergências de um hospital universitário e seguidos até o desfecho clínico. MÉTODO: Estudo epidemiológico, prospectivo e observacional, realizado em um hospital público do sul do Brasil, no período de 1 ano (agosto de 2013 a agosto de 2014). A coleta dos dados clínico-epidemiológicos utilizou fichas de notificação de sepse, prontuários e dados do setor de custos. Foi realizada análise de tendência central, dispersão e quartis dos custos das internações. RESULTADOS: Amostra composta por 95 pacientes que totalizaram elevado custo da internação (R$ 3.692.421,00), com média de R$ 38.867,60 por paciente. Mais da metade do valor total do tratamento da sepse (R$ 2.215.773,50) destinou-se a pacientes que evoluíram a óbito (59,0%). Os maiores custos foram relacionados à alta, ao diagnóstico de sepse grave, ao foco infeccioso pulmonar e à faixa etária até os 59 anos. CONCLUSÃO: O elevado custo com o tratamento da sepse justificam investimentos em ações de capacitação e instituição de protocolos que possam direcionar ações preventivas, otimizar o diagnóstico e a terapêutica em pacientes infectados e séptico.

HIV and AIDS in the state of Paraná, Brazil, 2007-2022: trends and spatiotemporal distribution.

OBJECTIVE: The aim of this study was to analyze the spatiotemporal evolution of the incidence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the state of Paraná, Brazil. METHODS: An ecological study with an analytical component of time series analysis was conducted in the state of Paraná from 2007 to 2022. The data source was the Notifiable Diseases Information System. To study the trend, the Prais-Winsten generalized linear regression model was used by decomposing the time series, and for spatial analysis, the Moran's index was applied. RESULTS: The total sample consisted of 50,676 HIV/AIDS records. The incidence rate showed an increasing trend, with an average growth of 2.14% [95% confidence interval - 95%CI 1.16-3.13] per month. From 2007 to 2014 and from 2015 to 2022, the average number of cases in the state was 105.64 and 159.20 per 100,000 inhabitants, respectively, with significant variation among municipalities. Spatial clusters of high risk persisted in the metropolitan region, the capital, and coastal areas, and a new cluster was observed in the northern region of the state. CONCLUSION: The incidence rates of HIV/AIDS showed an upward trend over time. The number of cases varied considerably in some municipalities, especially in the coastal region. Spatial analysis revealed geospatial patterns of high risk in the main metropolitan areas of Paraná: Curitiba (including the coastal area), Londrina, and Maringá, which share characteristics such as a high degree of urbanization and ongoing economic development.

"Educational Material on HIV": validity of health educational technology for people living with HIV.

OBJECTIVES: to validate the educational technology "Educational Material on HIV" (INPI - BR 10 2020 003765 0). METHODS: a methodological study with 39 expert judges in HIV/AIDS, using a 5-point Likert scale for assessment. Data were tabulated, processed and analyzed through descriptive analysis. Cronbach's alpha and McDonald's omega tests were performed to analyze internal consistency, and the Intraclass Correlation Coefficient, for reliability. Agreement was established by a Level Content Validity Index greater than 0.90. RESULTS: the assessment instrument showed high internal consistency (Cronbach's alpha of 0.89; McDonald's omega of 0.91) with reliable values. Based on the Intraclass Correlation Coefficient, judges' answers showed acceptable reliability, mean score 0.89 (p<0.001). Agreement among judges was greater than 0.90 in the three assessed dimensions (objectives, presentation and relevance). CONCLUSIONS: the technology was considered a qualified and adequate tool by the judges regarding its objectives, presentation and relevance.

Development of a Melting-Curve-Based Multiplex Real-Time PCR Assay for the Simultaneous Detection of Viruses Causing Respiratory Infection.

The prompt and accurate identification of the etiological agents of viral respiratory infections is a critical measure in mitigating outbreaks. In this study, we developed and clinically evaluated a novel melting-curve-based multiplex real-time PCR (M-m-qPCR) assay targeting the RNA-dependent RNA polymerase (RdRp) and nucleocapsid phosphoprotein N of SARS-CoV-2, the Matrix protein 2 of the Influenza A virus, the RdRp domain of the L protein from the Human Respiratory Syncytial Virus, and the polyprotein from Rhinovirus B genes. The analytical performance of the M-m-qPCR underwent assessment using in silico analysis and a panel of reference and clinical strains, encompassing viral, bacterial, and fungal pathogens, exhibiting 100% specificity. Moreover, the assay showed a detection limit of 10 copies per reaction for all targeted pathogens using the positive controls. To validate its applicability, the assay was further tested in simulated nasal fluid spiked with the viruses mentioned above, followed by validation on nasopharyngeal swabs collected from 811 individuals. Among them, 13.4% (109/811) tested positive for SARS-CoV-2, and 1.1% (9/811) tested positive for Influenza A. Notably, these results showed 100% concordance with those obtained using a commercial kit. Therefore, the M-m-qPCR exhibits great potential for the routine screening of these respiratory viral pathogens.

Managed clinical protocol: impact of implementation on sepsis treatment quality indicators.

OBJECTIVES: to assess the impact of the implementation of a managed sepsis protocol on quality indicators of treatment for septic patients in an emergency department of a university hospital. METHODS: an observational epidemiological study involving septic patients. The study was divided into two phases, pre-intervention and intervention, resulting from the implementation of the managed sepsis protocol. The study variables included sepsis treatment quality indicators. The results were statistically analyzed using the program Epi InfoTM. RESULTS: the study sample included 631 patients, 95 from pre-intervention phase and 536 from intervention phases. Implementing the protocol increased patients' chances of receiving the recommended treatment by 14 times. Implementing the protocol reduced the hospitalization period by 6 days (p <0.001) and decreased mortality (p <0.001). CONCLUSIONS: this study showed that implementing the managed protocol had an impact on the improvement of sepsis treatment quality indicators.

Methicillin-Resistant Staphylococcus haemolyticus Displaying Reduced Susceptibility to Vancomycin and High Biofilm-Forming Ability.

BACKGROUND: Staphylococcus haemolyticus is one of the most frequently coagulasenegative staphylococci isolated from healthcare-associated infections, mainly those related to implanted medical devices. OBJECTIVES: This study aimed to determine the antimicrobial susceptibility profile and biofilm forming capacity of S. haemolyticus isolated from bloodstream infections. METHODS: A total of 40 S. haemolyticus isolates were characterized according to their genetic relatedness by repetitive element sequence based-PCR (REP-PCR), antimicrobial susceptibility profile, SCCmec typing, ability to form biofilm on abiotic surface and occurrence of putative genes related to biofilm formation. RESULTS: One S. haemolyticus was susceptible to all antimicrobials. The other isolates (n=39) were resistant to cefoxitin; and among them 34 (87.2%) harbored the mecA gene into the SCCmec type I (5.9%), type III (29.4%), type IV (5.9%) and type V (20.6%); and 38.2% isolates were designated as NT. Apart from cefoxitin, 94.9% of the isolates were resistant to at least four antimicrobial classes, and 32.5% displayed minimal inhibitory concentration (MIC) values higher than 4.0 µg/mL for vancomycin. All isolates formed biofilm on polystyrene surface and were classified as strong biofilm-producers, except for one isolate. All isolates were negative for icaA gene, and the prevalence of the other genes was as follows: atl, 100%; fbp, 92.5%; aap, 90.0%; and bap, 20.0%. CONCLUSION: This study reports a high prevalence of methicillin-resistant S. haemolyticus displaying decreased susceptibility to vancomycin with the ability to form strong biofilms on abiotic surface. The results support the importance of controlling the adequate use of antimicrobials for the treatment of staphylococcal infections.

Colonization profile and duration by multi-resistant organisms in a prospective cohort of newborns after hospital discharge.

The aim of this study was to determine the spontaneous decolonization period and characteristics in a prospective cohort of newborns colonized by multidrug-resistant organisms, after their discharge from the neonatal intensive care unit. Multidrug resistance is defined as bacterial non-susceptibility to ≥ 1 agent of ≥ 3 antimicrobial categories. In total, 618 newborns were included in the study, of which 173 (28.0%) presented a positive culture for multidrug-resistant microorganisms, and of these, 52 (30.1%) were followed up in this study. The most frequent intrinsic factors were be born by cesarean section (86.5%), prematurity (84.6%), and very low birth weight (76.9%). The extrinsic factors were having remained hospitalized for an average of 27 days, during which 67.3% were submitted to invasive procedures and 88.5% received antimicrobials. The intrinsic and extrinsic factors of newborns were not associated to a decolonization period longer or shorter than 3 months, which was the average period of decolonization found in the present study. From the totality of colonization cultures sampled at hospital discharge, the Gram-negative Extended Spectrum ß-lactamase producing bacteria were the most common, with 28.9% of babies colonized by Klebsiella spp. The median period of decolonization by multidrug-resistant microorganisms in the newborns population after hospital discharge was 3 months, but was highly dependent on the microbial species, and this period was not associated to any intrinsic and extrinsic factors of the newborn.

Colonization by multidrug-resistant microorganisms of hospitalized newborns and their mothers in the neonatal unit context.

INTRODUCTION: The mother plays a fundamental role in the constitution and regulation of her child's healthy microbiota, however, preterm newborns are separated from their mothers soon after birth and transferred to Neonatal Intensive Care Units, being exposed the constant risk for the development of multidrug-resistant microorganisms' infections. The aim of this study was to explore the multidrug-resistant microorganism colonization of hospitalized babies and their mothers in the neonatal unit context. METHODOLOGY: A prospective case study conducted with hospitalized babies and their mothers in the Neonatal Unit at a university hospital. The sample was composed of 433 binomials (mother-child). Colonization culture samples were taken at the moment of the baby's discharge, via two swabs in the oral, nasal, axillary, inguinal, and rectal regions. RESULTS: The colonization incidence among the binomials, 30 (6.9%) were both colonized by multi-resistant microorganisms. Mothers of colonized babies (24.4%) demonstrated a higher chance of colonization in comparison to mothers of non-colonized babies (11.9%) (p = 0.002). Relationships were drawn between baby colonization and prematurity, extremely low birth weight, and non-exclusive maternal breastfeeding (p<0.05). ESBL-producing Gram-negative microorganisms were more frequent in the cultures of the binomials, with 35.9% of the babies colonized with Klebsiella spp. ESBL and 42.0% of the mothers with Escherichia coli ESBL. Furthermore, 50% of the binomials were colonized with E. coli ESBL. CONCLUSION: The prematurity, extremely low birth weight, and non-exclusive breastfeeding at hospital discharge were associated with baby colonization by multidrug-resistant microorganism. Furthermore, mothers of colonized children presented higher chances of colonization.

Impact of healthcare-associated infections on the hospitalization costs of children. / Impacto das infecções relacionadas à assistência à saúde nos custos da hospitalização de crianças.

OBJECTIVE: To evaluate the impact of Healthcare-Associated Infections on the hospitalization cost of children. METHOD: A prospective, quantitative cohort study involving children admitted to the Inpatient and Pediatric Intensive Care Units of a public university hospital. The data were analyzed through SPSS software by frequency distribution, central tendency measures and dispersion. The level of statistical significance was set at p<0.05 for all analyzes. RESULTS: The sample consisted of 173 children, of whom 18.5% developed Healthcare-Associated Infections, which increased the hospitalization costs 4.2 times (p<0.001). A greater cost impact was observed among patients with two or more infectious sites (R$81,037.57; p=0.010) and sepsis (R$46,315.63; p<0.001). Children colonized by multiresistant microorganisms with a prevalence of E. coli and A. baumannii ESBL also generated higher costs of R$35,206.15 and R$30,692.52, respectively. CONCLUSION: Healthcare-Associated Infections significantly increased the hospitalization costs for children, especially among those with more than two infectious sites, who developed sepsis or were colonized by multiresistant microorganisms.

HIV and AIDS in the state of Paraná, Brazil, 2007-2022: trends and spatiotemporal distribution / HIV e AIDS no Estado do Paraná, Brasil, 2007-2022: tendência e distribuição espaçotemporal

ABSTRACT Objective: The aim of this study was to analyze the spatiotemporal evolution of the incidence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the state of Paraná, Brazil. Methods: An ecological study with an analytical component of time series analysis was conducted in the state of Paraná from 2007 to 2022. The data source was the Notifiable Diseases Information System. To study the trend, the Prais-Winsten generalized linear regression model was used by decomposing the time series, and for spatial analysis, the Moran's index was applied. Results: The total sample consisted of 50,676 HIV/AIDS records. The incidence rate showed an increasing trend, with an average growth of 2.14% [95% confidence interval - 95%CI 1.16-3.13] per month. From 2007 to 2014 and from 2015 to 2022, the average number of cases in the state was 105.64 and 159.20 per 100,000 inhabitants, respectively, with significant variation among municipalities. Spatial clusters of high risk persisted in the metropolitan region, the capital, and coastal areas, and a new cluster was observed in the northern region of the state. Conclusion: The incidence rates of HIV/AIDS showed an upward trend over time. The number of cases varied considerably in some municipalities, especially in the coastal region. Spatial analysis revealed geospatial patterns of high risk in the main metropolitan areas of Paraná: Curitiba (including the coastal area), Londrina, and Maringá, which share characteristics such as a high degree of urbanization and ongoing economic development.

RESUMO Objetivo: Este estudo teve como objetivo analisar a evolução espaçotemporal das taxas de incidência do vírus da imunodeficiência humana (HIV) e da síndrome da imunodeficiência adquirida (AIDS) no estado do Paraná, Brasil. Métodos: Foi realizado um estudo ecológico com componente analítico de séries temporais e análise espacial no estado do Paraná, de 2007 a 2022. A fonte de dados foi o Sistema de Informação de Agravos de Notificação. Para estudar a tendência, foi utilizado o modelo de regressão linear generalizada de Prais-Winsten por meio da decomposição de séries temporais e, para a análise espacial, foi aplicado o Índice de Moran. Resultados: A amostra total foi composta de 50.676 registros de HIV/AIDS. A taxa de incidência apresentou tendência crescente, com crescimento médio de 2,14% (intervalo de confiança de 95% — IC95% 1,16-3,13) ao mês. Nos períodos de 2007 a 2014 e 2015 a 2022, a média de casos no estado foi de 105,64 e 159,20 a cada 100 mil habitantes, respectivamente, com importantes variações entre os municípios. Agrupamentos espaciais de alto risco permaneceram na região metropolitana à capital e litoral e um novo agrupamento foi observado à região norte do estado. Conclusão: As taxas de incidência do HIV/AIDS apresentaram tendência temporal crescente. O número de casos variou substancialmente em alguns municípios, principalmente naqueles localizados na região litorânea. A análise espacial revelou padrões geoespaciais de alto risco nas principais regiões metropolitanas do Paraná: Curitiba (abrange o litoral), Londrina e Maringá, as quais compartilham características como elevado grau de urbanização e constante desenvolvimento econômico.

Hydrogel Containing Oleoresin From Copaifera officinalis Presents Antibacterial Activity Against Streptococcus agalactiae.

Streptococcus agalactiae or Group B Streptococcus (GBS) remains a leading cause of neonatal infections worldwide; and the maternal vaginal-rectal colonization increases the risk of vertical transmission of GBS to neonates and development of infections. This study reports the in vitro antibacterial effect of the oleoresin from Copaifera officinalis Jacq. L. in natura (copaiba oil) and loaded into carbomer-hydrogel against planktonic and sessile cells of GBS. First, the naturally extracted copaiba oil was tested for the ability to inhibit the growth and metabolic activity of planktonic and sessile GBS cells. The time-kill kinetics showed that copaiba oil exhibited a dose-dependent bactericidal activity against planktonic GBS strains, including those resistant to erythromycin and/or clindamycin [minimal bactericidal concentration (MBC) ranged from 0.06 mg/mL to 0.12 mg/mL]. Copaiba oil did not inhibit the growth of different Lactobacillus species, the indigenous members of the human microbiota. The mass spectral analyses of copaiba oil showed the presence of diterpenes, and the kaurenoic acid appears to be one of the active components of oleoresin from C. officinalis related to antibacterial activity against GBS. Microscopy analyses of planktonic GBS cells treated with copaiba oil revealed morphological and ultrastructural alterations, displaying disruption of the cell wall, damaged cell membrane, decreased electron density of the cytoplasm, presence of intracellular condensed material, and asymmetric septa. Copaiba oil also exhibited antibacterial activity against established biofilms of GBS strains, inhibiting the viability of sessile cells. Low-cost and eco-friendly carbomer-based hydrogels containing copaiba oil (0.5% - CARB-CO 0.5; 1.0% - CARB-CO 1.0) were then developed. However, only CARB-CO 1.0 preserved the antibacterial activity of copaiba oil against GBS strains. This formulation was homogeneous, soft, exhibited a viscoelastic behavior, and showed good biocompatibility with murine vaginal mucosa. Moreover, CARB-CO 1.0 showed a slow and sustained release of the copaiba oil, killing the planktonic and sessile (established biofilm) cells and inhibiting the biofilm formation of GBS on pre-coated abiotic surface. These results indicate that carbomer-based hydrogels may be useful as topical systems for delivery of copaiba oil directly into de vaginal mucosa and controlling S. agalactiae colonization and infection.

"Educational Material on HIV": validity of health educational technology for people living with HIV / "Material Educativo sobre VIH": validación de tecnología educativa en salud para personas que viven con VIH / "Material Educativo sobre HIV": validação de tecnologia educacional em saúde para pessoas vivendo com HIV

ABSTRACT Objectives: to validate the educational technology "Educational Material on HIV" (INPI - BR 10 2020 003765 0). Methods: a methodological study with 39 expert judges in HIV/AIDS, using a 5-point Likert scale for assessment. Data were tabulated, processed and analyzed through descriptive analysis. Cronbach's alpha and McDonald's omega tests were performed to analyze internal consistency, and the Intraclass Correlation Coefficient, for reliability. Agreement was established by a Level Content Validity Index greater than 0.90. Results: the assessment instrument showed high internal consistency (Cronbach's alpha of 0.89; McDonald's omega of 0.91) with reliable values. Based on the Intraclass Correlation Coefficient, judges' answers showed acceptable reliability, mean score 0.89 (p<0.001). Agreement among judges was greater than 0.90 in the three assessed dimensions (objectives, presentation and relevance). Conclusions: the technology was considered a qualified and adequate tool by the judges regarding its objectives, presentation and relevance.

RESUMEN Objetivos: validar la tecnología educativa "Material Educativo sobre VIH" (INPI - BR 10 2020 003765 0). Métodos: estudio metodológico con 39 jueces expertos en VIH/SIDA, utilizando una escala Likert de 5 puntos para evaluación. Los datos fueron tabulados, procesados y analizados mediante análisis descriptivo. Se realizaron las pruebas alfa de Cronbach y omega de McDonald para analizar la consistencia interna y el Intraclass Correlation Coefficient para la confiabilidad. La concordancia fue establecida por un Level Content Validity Index superior a 0,90. Resultados: el instrumento de evaluación mostró alta consistencia interna (alfa de Cronbach de 0,89; omega de McDonald de 0,91) con valores confiables. Con base en el Intraclass Correlation Coefficient, las respuestas de los jueces mostraron una confiabilidad aceptable, puntaje promedio de 0,89 (p<0,001). La concordancia entre jueces fue superior a 0,90 en las tres dimensiones evaluadas (objetivos, presentación y relevancia). Conclusiones: la tecnología fue considerada una herramienta calificada y adecuada por los jueces en cuanto a sus objetivos, presentación y pertinencia.

RESUMO Objetivos: validar a tecnologia educacional "Material Educativo sobre HIV" (INPI - BR 10 2020 003765 0). Métodos: estudo metodológico com 39 juízes experts em HIV/AIDS, utilizando escala Likert de 5 pontos para avaliação. Os dados foram tabulados, processados e analisados mediante análise descritiva. Realizaram-se os Testes alfa de Cronbach e ômega de McDonald para análise da consistência interna, e Intraclass Correlation Coefficient, para confiabilidade. A concordância foi estabelecida pelo Level Content Validity Index maior que 0,90. Resultados: o instrumento de avaliação apresentou alta consistência interna (alfa de Cronbach de 0,89; ômega de McDonald de 0,91) com valores confiáveis. A partir do Intraclass Correlation Coefficient, as respostas dos juízes apresentaram confiabilidade aceitável, escore médio 0,89 (p<0,001). A concordância entre os juízes foi superior a 0,90 nas três dimensões avaliadas (objetivos, apresentação e relevância). Conclusões: a tecnologia foi considerada uma ferramenta qualificada e adequada pelos juízes quanto aos seus objetivos, apresentação e relevância.

Representações sociais de pessoas vivendo com hiv: do abandono do tratamento à motivação para a retomada / Representaciones sociales de las personas que viven con vih: del abandono del tratamiento a la motivación para reanudar / Social representations of people living with hiv: from treatment abandonment to motivation for resuming

Introdução: O uso contínuo da terapia antirretroviral é eficiente para interromper a replicação viral causada pelo Vírus da Imunodeficiência Humana impedindo o comprometimento do sistema imunológico e o aparecimento das infecções oportunistas. Estima-se que em 2021, 10,2 milhões de pessoas infectadas pelo HIV não se beneficiaram com o uso dos antirretrovirais em todo o mundo. No mesmo ano esse indicador atingiu 333 mil pessoas, e na esfera municipal de Londrina, 288 pessoas vivendo com HIV encontravam-se em abandono do tratamento. Objetivo: Apreender as representações sociais de pessoas vivendo com HIV acerca do abandono do tratamento e a motivação para a retomada. Percurso metodológico: Trata-se de um estudo qualitativo pautado na Teoria das Representações Sociais de Serge Moscovici. O cenário foi um Serviço de Atendimento Especializado em HIV/aids localizado na região Sul do Brasil. A população foi composta por 288 pessoas diagnosticadas com HIV em abandono do tratamento por período superior a 100 dias. Destas, 250 foram excluídas em função de critérios relacionados a informações cadastrais incompletas ou equivocadas, e aspectos impeditivos do comparecimento ao serviço e de contato. Outras 18 pessoas foram consideradas perdas por desistência. A amostra foi composta por 20 pessoas que se enquadraram aos critérios de elegibilidade e aceitaram participar do estudo. A coleta das informações ocorreu entre junho de 2021 e junho de 2022 em entrevistas semiestruturadas audiogravadas e transcritas na íntegra. Para análise das falas foi utilizado o discurso do sujeito coletivo. Resultados: Participaram do estudo 20 pessoas vivendo com HIV, sendo 12 homens e oito mulheres, com idade entre 27 e 55 anos. O tempo de abandono variou entre 210 e 1580 dias. A análise das entrevistas permitiu a emersão de 18 ideias centrais e duas ancoragens, as quais foram agrupadas em quatro grandes temas: 1) Abandono do tratamento por questões intrínsecas à pessoa vivendo com HIV; 2) Abandono do tratamento por questões ligadas à terapia medicamentosa; 3) Abandono do tratamento por dogmas sociais; 4) Forças propulsoras para a retomada do tratamento. Considerações finais: A análise qualitativa das representações sociais das pessoas vivendo com HIV indicou que o abandono da terapia antirretroviral é multifatorial, e envolve questões socioculturais, geográficas, familiares e biológicas. É essencial considerar todas as questões que permeiam e impactam as vidas das pessoas vivendo com HIV em abandono do tratamento para além das questões biológicas, viabilizando a implementação de ações que contribuam para a efetividade das políticas públicas de saúde no intuito de estimular a adesão e encorajar a retomada ao tratamento. Almeja-se que esta investigação possa despertar para as questões subjetivas ao universo da pessoa que vive com HIV e estas respeitadas na prática humanizada, voltadas ao incentivo do tratamento contínuo para controle da infecção e promoção da qualidade de vida.

Introduction: The continuous use of antiretroviral therapy is efficient to interrupt viral replication caused by the Human Immunodeficiency Virus, preventing the compromise of the immune system and the appearance of opportunistic infections. It is estimated that in 2021, 10.2 million people infected with HIV did not benefit from the use of antiretrovirals worldwide. In the same year, this indicator reached 333,000 people, and at the municipal level of Londrina, 288 people living with HIV were abandoning treatment. Objective: To apprehend the social representations of people living with HIV about abandoning treatment and the motivation for resuming it. Methodological path: This is a qualitative study based on Serge Moscovici's Theory of Social Representations. The setting was a Specialized Care Service for HIV/AIDS located in the south of Brazil. The population consisted of 288 people diagnosed with HIV who had abandoned treatment for more than 100 days. Of these, 250 were excluded due to criteria related to incomplete or wrong registration information, and aspects that impeded attendance at the service and contact. Another 18 people were considered dropout losses. The sample consisted of 20 people who met the eligibility criteria and agreed to participate in the study. Data collection took place between June 2021 and June 2022 in semi-structured interviews that were audio-recorded and transcribed in full. For the analysis of the speeches, the collective subject discourse was used. Results: 20 people living with HIV participated in the study, 12 men and eight women, aged between 27 and 55 years. The abandonment time varied between 210 and 1580 days. The analysis of the interviews allowed the emergence of 18 central ideas and two anchors, which were grouped into four major themes: 1) Abandonment of treatment due to issues intrinsic to the person living with HIV; 2) Abandonment of treatment due to issues related to drug therapy; 3) Abandonment of treatment by social dogmas; 4) Driving forces for the resumption of treatment. Final considerations: The qualitative analysis of the social representations of people living with HIV indicated that the abandonment of antiretroviral therapy is multifactorial, and involves sociocultural, geographic, family and biological issues. It is essential to consider all the issues that permeate and impact the lives of people living with HIV who abandon treatment in addition to biological issues, enabling the implementation of actions that contribute to the effectiveness of public health policies in order to stimulate adherence and encourage resumption of treatment. It is hoped that this investigation may awaken to the subjective issues of the universe of the person living with HIV and these respected in humanized practice, aimed at encouraging continuous treatment to control the infection and promote quality of life.

Introducción: El uso continuo de la terapia antirretroviral es eficaz para interrumpir la replicación viral provocada por el Virus de la Inmunodeficiencia Humana, previniendo el compromiso del sistema inmunológico y la aparición de infecciones oportunistas. Se estima que en 2021, 10,2 millones de personas infectadas por el VIH no se beneficiaron del uso de antirretrovirales en todo el mundo. En el mismo año, este indicador alcanzó a 333.000 personas, ya nivel municipal de Londrina, 288 personas viviendo con VIH estaban abandonando el tratamiento. Objetivo: Aprehender las representaciones sociales de personas viviendo con VIH sobre el abandono del tratamiento y la motivación para retomarlo. Camino metodológico: Se trata de un estudio cualitativo basado en la Teoría de las Representaciones Sociales de Serge Moscovici. El escenario fue un Servicio de Atención Especializada en VIH/SIDA ubicado en el sur de Brasil. La población estuvo conformada por 288 personas diagnosticadas con VIH que habían abandonado el tratamiento por más de 100 días. De estos, 250 fueron excluidos por criterios relacionados con información de registro incompleta o incorrecta, y aspectos que impidieron la asistencia al servicio y contacto. Otras 18 personas fueron consideradas pérdidas por deserción. La muestra estuvo conformada por 20 personas que cumplieron con los criterios de elegibilidad y aceptaron participar en el estudio. La recolección de datos ocurrió entre junio de 2021 y junio de 2022 en entrevistas semiestructuradas que fueron grabadas en audio y transcritas en su totalidad. Para el análisis de los discursos se utilizó el discurso del sujeto colectivo. Resultados: Participaron del estudio 20 personas viviendo con VIH, 12 hombres y ocho mujeres, con edades entre 27 y 55 años. El tiempo de abandono varió entre 210 y 1580 días. El análisis de las entrevistas permitió el surgimiento de 18 ideas centrales y dos anclas, que fueron agrupadas en cuatro grandes temas: 1) Abandono del tratamiento por cuestiones intrínsecas a la persona que vive con VIH; 2) Abandono del tratamiento por cuestiones relacionadas con la farmacoterapia; 3) Abandono de tratamiento por dogmas sociales; 4) Fuerzas impulsoras de la reanudación del tratamiento. Consideraciones finales: El análisis cualitativo de las representaciones sociales de las personas viviendo con VIH indicó que el abandono de la terapia antirretroviral es multifactorial, e involucra cuestiones socioculturales, geográficas, familiares y biológicas. Es fundamental considerar todas las cuestiones que permean e impactan la vida de las personas que viven con el VIH que abandonan el tratamiento además de las cuestiones biológicas, posibilitando la implementación de acciones que contribuyan a la efectividad de las políticas públicas de salud para estimular la adherencia y alentar la reanudación. De tratamiento se espera que esta investigación pueda despertar a las cuestiones subjetivas del universo de la persona que vive con VIH y estas respetadas en la práctica humanizada, con el objetivo de incentivar el tratamiento continuo para el control de la infección y promover la calidad de vida.

Relato de experiência de educação em saúde para pessoas vivendo com hiv: integração ensino e serviço / Experience report on health education for people living with hiv: integration teaching and service / Informe de experiencia en educación en salud para personas que viven con vih: enseñanza y servicio de integración

A educação em saúde e o acesso à informação são ferramentas estratégicas para a promoção do autocuidado de pessoas vivendo com HIV. Apesar dos grandes avanços científicos, sobretudo quanto ao uso da TARV, ainda existem desafios a serem enfrentados como o preconceito, o estigma e a desinformação da população. Nesse sentido, tal estratégia contribui com a adesão ao tratamento, por meio do esclarecimento de dúvidas a cerca da infecção pelo HIV. Trata-se de um relato de experiência referente às ações de educação em saúde realizadas em serviços especializados de saúde para o tratamento de pessoas vivendo com HIV. Os participantes do projeto foram capacitados e realizaram ações de educação em saúde, para abordar temas relacionados ao HIV/Aids e para o esclarecimento de dúvidas a respeito da terapia antirretroviral. Conclui-se que a integração dos serviços de saúde com as instituições de ensino se constitui com uma importante estratégia para o desenvolvimento de reflexões críticas acerca da temática, bem como para auxiliar nos cuidados direcionados às pessoas que vivem com HIV. PALAVRAS-CHAVE: Educação em Saúde; HIV; Terapia Antirretroviral; Adesão ao Tratamento.

Health education and access to information are strategic tools for promoting self-care for people living with HIV. Despite the great scientific advances, especially regarding the use of ART, there are still challenges to be faced, such as prejudice, stigma and misinformation of the population. In this sense, such a strategy contributes to adherence to treatment, by clarifying doubts about HIV infection. This is an experience report regarding health education actions carried out in specialized health services for the treatment of people living with HIV. Project participants were trained and carried out health education actions to address issues related to HIV/AIDS and to clarify doubts about antiretroviral therapy. It is concluded that the integration of health services with educational institutions constitutes an important strategy for the development of critical reflections on the subject, as well as to assist in the care directed to people living with HIV.

La educación sanitaria y el acceso a la información son herramientas estratégicas para promover el autocuidado de las personas que viven con VIH. Apesar de los grandes avances científicos, especialmente en lo que respecta al uso de las TAR, todavía quedan desafíos por afrontar, como los prejuicios, el estigma y la desinformación de la población. En este sentido, dicha estrategia contribuye a la adherencia al tratamiento, al aclarar dudas sobre la infección por VIH. Este es un relato de experiencia sobre acciones de educación en salud realizadas en servicios de salud especializados para el tratamiento de personas que viven con VIH. Los participantes del proyecto fueron capacitados y realizaron acciones de educación en salud para abordar temas relacionados con el VIH/SIDA y aclarar dudas sobre la terapia antirretroviral. Se concluye que la integración de los servicios de salud con las instituciones educativas constituye una estrategia importante para el desarrollo de reflexiones críticas sobre el tema, así como para coadyuvar en la atención dirigida a las personas que viven con VIH.

Microbiological environmental contamination in a Pediatric Intensive Care Unit / Contaminação ambiental microbiológica em Unidade de Terapia Intensiva Pediátrica / Contaminación ambiental microbiológica en una Unidad de Cuidados Intensivos Pediátricos

Background and objectives: inanimate surfaces and equipment in the hospital environment are considered reservoirs of resistant and pathogenic microorganisms. In Pediatric Intensive Care Units, the risk of infection is also related to the severity of pathologies associated with the immaturity of the immune system of this population. This study aimed to investigate microbiological environmental contamination in a Pediatric Intensive Care Unit. Method: this is an exploratory cross-sectional study, carried out in a Pediatric Intensive Care Unit of a highly complex university hospital, located in southern Brazil. To assess environmental contamination, sterile swabs were rubbed on surfaces corresponding to the patient unit and in the common area. Results: twenty-eight surfaces were analyzed, 12 of which were located in units occupied by patients at the time of collection and 16 surfaces in the common use area. In the total number of surfaces analyzed by microbiological cultures, the patient unit showed 66.67% contamination by microorganisms, while surfaces in the common area showed 56.25%. Regarding the microbiological profile, all isolated microorganisms were Gram-positive and showed resistance, namely Staphylococcus aureus and coagulase-negative Staphylococcus. Conclusion: there was evidence of a high frequency of contamination on inanimate surfaces and equipment near and far from patients, essentially by pathogenic and multi-resistant microorganisms to antimicrobials.(AU)

Justificativa e objetivos: superfícies e equipamentos inanimados no ambiente hospitalar são considerados reservatórios de microrganismos resistentes e patogênicos. Nas Unidades de Cuidados Intensivos Pediátricos, o risco de infeção também está relacionado com a gravidade das patologias associadas à imaturidade do sistema imunitário desta população. Este estudo teve como objetivo investigar a contaminação microbiológica ambiental em uma Unidade de Terapia Intensiva Pediátrica. Método: trata-se de um estudo exploratório transversal, realizado em uma Unidade de Terapia Intensiva Pediátrica de um hospital universitário de alta complexidade, localizado no Sul do Brasil. Para avaliar a contaminação ambiental, foram esfregados swabs estéreis nas superfícies correspondentes à unidade do paciente e na área comum. Resultados: foram analisadas vinte e oito superfícies, sendo 12 localizadas em unidades ocupadas por pacientes no momento da coleta e 16 superfícies em área de uso comum. No total de superfícies analisadas por culturas microbiológicas, a unidade paciente apresentou 66,67% de contaminação por microrganismos, enquanto as superfícies da área comum apresentaram 56,25%. Quanto ao perfil microbiológico, todos os microrganismos isolados eram Gram-positivos e apresentavam resistência, nomeadamente Staphylococcus aureus e Staphylococcus coagulase-negativa. Conclusão: houve evidência de elevada frequência de contaminação em superfícies inanimadas e equipamentos próximos e distantes dos pacientes, essencialmente por microrganismos patogênicos e multirresistentes aos antimicrobianos.(AU)

Fundamento y objetivos: las superficies y equipos inanimados del ambiente hospitalario son considerados reservorios de microorganismos resistentes y patógenos. En las Unidades de Cuidados Intensivos Pediátricos el riesgo de infección también se relaciona con la gravedad de patologías asociadas a la inmadurez del sistema inmunológico de esta población. Este estudio tuvo como objetivo investigar la contaminación ambiental microbiológica en una Unidad de Cuidados Intensivos Pediátricos. Método: se trata de un estudio exploratorio transversal, realizado en una Unidad de Cuidados Intensivos Pediátricos de un hospital universitario de alta complejidad, ubicado en el sur de Brasil. Para evaluar la contaminación ambiental se frotaron hisopos estériles en las superficies correspondientes a la unidad de pacientes y en el área común. Resultados: se analizaron veintiocho superficies, 12 de las cuales estaban ubicadas en unidades ocupadas por los pacientes en el momento de la recogida y 16 superficies en el área de uso común. Del total de superficies analizadas por cultivos microbiológicos, la unidad de pacientes presentó un 66,67% de contaminación por microorganismos, mientras que las superficies del área común presentaron un 56,25%. En cuanto al perfil microbiológico, todos los microorganismos aislados fueron Gram positivos y presentaron resistencia, concretamente Staphylococcus aureus y Staphylococcus coagulasa negativo. Conclusión: se evidenció alta frecuencia de contaminación en superficies inanimadas y equipos cercanos y lejanos de los pacientes, esencialmente por microorganismos patógenos y multirresistentes a los antimicrobianos.(AU)

Antibacterial Combination of Oleoresin from Copaifera multijuga Hayne and Biogenic Silver Nanoparticles Towards Streptococcus agalactiae.

BACKGROUND: Streptococcus agalactiae (group B Streptococcus - GBS) remains a leading cause of neonatal infections and an important cause of invasive infections in adults with underlying conditions. METHODS: This study evaluated for the first time the effect of an oleoresin collected from Copaifera multijuga Hayne (copaiba oil) alone or in combination with silver nanoparticles produced by green synthesis using Fusarium oxysporum (AgNPbio) against planktonic and sessile cells of GBS isolated from colonized women. RESULTS: Copaiba oil showed a dose-dependent bactericidal activity against planktonic GBS strains, including those resistant to erythromycin and/or clindamycin. Scanning and transmission electron microscopy of GBS treated with copaiba oil revealed morphological and ultrastructural alterations, displaying disruption of the cell wall and decreased electron density due to leakage of cytoplasmic content. Copaiba oil also exhibited antibacterial activity against biofilms of GBS strains, inhibiting their formation as well as the viability of mature biofilms. In addition, the combination of copaiba oil with AgNPbio resulted in a synergistic effect against planktonic cells and biofilm formation, reducing the minimal inhibitory concentration values of both compounds. No hemolytic activity was detected for both compounds. CONCLUSION: These results indicate the potential of copaiba oil, alone or in combination with AgNPbio, for the development of new alternative strategies for controlling GBS infections.

Managed clinical protocol: impact of implementation on sepsis treatment quality indicators / Protocolo clínico gestionado: impacto de la implementación en los indicadores de calidad del tratamiento de la sepsis / Protocolo clínico gerenciado: impacto da implementação nos indicadores de qualidade do tratamento da sepse

ABSTRACT Objectives: to assess the impact of the implementation of a managed sepsis protocol on quality indicators of treatment for septic patients in an emergency department of a university hospital. Methods: an observational epidemiological study involving septic patients. The study was divided into two phases, pre-intervention and intervention, resulting from the implementation of the managed sepsis protocol. The study variables included sepsis treatment quality indicators. The results were statistically analyzed using the program Epi InfoTM. Results: the study sample included 631 patients, 95 from pre-intervention phase and 536 from intervention phases. Implementing the protocol increased patients' chances of receiving the recommended treatment by 14 times. Implementing the protocol reduced the hospitalization period by 6 days (p <0.001) and decreased mortality (p <0.001). Conclusions: this study showed that implementing the managed protocol had an impact on the improvement of sepsis treatment quality indicators.

RESUMEN Objetivos: evaluar el impacto de la implementación de un protocolo de sepsis manejada sobre los indicadores de calidad del tratamiento del paciente séptico en el servicio de urgencia de un hospital universitario. Métodos: estudio epidemiológico observacional con pacientes sépticos. El estudio se dividió en dos fases, preintervención e intervención, resultado de la implementación del protocolo de sepsis manejada. Las variables de estudio incluyeron indicadores de calidad del tratamiento de la sepsis. Los resultados fueron analizados estadísticamente por el programa Epi InfoTM. Resultados: la muestra de estudio incluyó a 631 pacientes, 95 de la fase de preintervención y 536 de la fase de intervención. La implementación del protocolo aumentó 14 veces las posibilidades de que el paciente recibiera el tratamiento recomendado. La implementación del protocolo redujo el período de hospitalización en 6 días (p<0,001) y disminuyó la mortalidad (p<0,001). Conclusiones: el estudio mostró que la implementación del protocolo gestionado incidió en la mejora de los indicadores de calidad en el tratamiento de la sepsis.

RESUMO Objetivos: avaliar o impacto da implementação de protocolo clínico gerenciado de sepse nos indicadores de qualidade do tratamento de pacientes sépticos atendidos em setor de urgência e emergência de um hospital universitário. Métodos: estudo epidemiológico observacional envolvendo pacientes sépticos. O estudo se dividiu em duas fases, pré-intervenção e intervenção, decorrente da implementação do protocolo gerenciado de sepse. As variáveis do estudo contemplaram os indicadores de qualidade do tratamento da sepse. Os resultados foram analisados estatisticamente pelo programa Epi InfoTM. Resultados: a amostra do estudo contemplou 631 pacientes, 95 da fase pré-intervenção e 536 da fase intervenção. A implementação do protocolo aumentou em 14 vezes as chances de o paciente receber o tratamento recomendado. A implementação do protocolo reduziu em 6 dias o período de hospitalização (p<0,001) e diminuiu a mortalidade (p<0,001). Conclusões: o estudo evidenciou que a implementação do protocolo gerenciado impactou na melhoria dos indicadores de qualidade no tratamento da sepse.

Infecção relacionada à assistência à saúde e sepse na hospitalização em pediatria / Infección relacionada con la atención a la salud y sepsis en hospitalización en pediatría / Infection related to health care and sepsis in hospitalization in pediatrics

RESUMO Introdução: as infecções em pediatria são entraves no tratamento da criança hospitalizada, pois surgem com maior frequência, sendo um fator desencadeante de complicações no tratamento da criança hospitalizada. Objetivo: investigar a frequência das infecções relacionadas à assistência à saúde e sepse em crianças hospitalizadas. Método: trata-se de um estudo quantitativo prospectivo e descritivo. A coleta de dados ocorreu de julho a dezembro de 2015, por meio de 173 prontuários físicos e eletrônicos dos pacientes. Os dados foram analisados via Microsoft Office Excel® e análise descritiva. Resultados: identificou-se uma alta prevalência de infecções relacionadas à assistência à saúde com 31% (n= 54), tendo como principal causa a pneumonia, e destas 55% evoluíram para sepse (n=32). Conclusão: os achados permitem uma visão sobre a gravidade da ocorrência de infecções em crianças hospitalizadas, destacando a necessidade de capacitação da equipe de saúde para o reconhecimento precoce, com vistas à diminuição dos índices de infecção dentro dos serviços de saúde e melhoria na qualidade da assistência ofertadaà população pediátrica.

RESUMEN Introducción: las infecciones en pediatría son obstáculos en el tratamiento del niño hospitalizado, pues surgen con mayor frecuencia, siendo un factor desencadenante de complicaciones en el tratamiento del niño hospitalizado. Objetivo: investigar la frecuencia de las infecciones relacionadas con la atención a la salud y sepsis en niños hospitalizados. Método: se trata de un estudio cuantitativo prospectivo y descriptivo. La recolección de datos tuvo lugar de julio a diciembre de 2015, a través de 173 registros médicos, físicos y electrónicos, de los pacientes. Los datos fueron analizados vía Microsoft Office Excel® y análisis descriptivo. Resultados: se identificó una alta prevalencia de infecciones relacionadas con la atención a la salud con 31% (n=54), teniendo como principal causa la neumonía, y de estas 55% evolucionaron para sepsis (n=32). Conclusión: los hallazgos permiten una visión sobre la gravedad de la ocurrencia de infecciones en niños hospitalizados, destacando la necesidad de capacitación del equipo de salud para el reconocimiento precoz, con vistas a reducir los índices de infección dentro de los servicios sanitarios y mejorar la calidad de la atención ofrecida a la población pediátrica.

ABSTRACT Introduction: cross-infections are obstacles in the treatment of hospitalized children, as they are more frequently, and may be a triggering factor for complications in the treatment of hospitalized children. Objective: to investigate the frequency of healthcare-related infections and sepsis in hospitalized children. Method: this is a prospective and descriptive quantitative study. The data collection took place from July to December 2015, using 173 physical and electronic patient records. The data were analyzed using Microsoft Office Excel® and descriptive analysis. Results: a high prevalence of cross-infections was identified with 31% (n=54), having pneumonia as the main cause, and out of these 55% have progressed to sepsis (n=32). Conclusion: the findings allow an insight into the severity of the occurrence of infections in hospitalized children, highlighting the need for training the health team for early recognitionfor reducing infection rates within health services, and improving the quality of assistance offered to the pediatric population.