Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance.

Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

Disseminated Neonatal Monkeypox Virus Infection: Case Report in Brazil.

We present here a case of a newborn presenting with a vesicular rash on the scalp and thorax on day 9 of life. Vesicular fluid polymerase chain reaction testing confirmed the presence of Mpox virus DNA. Similar reports in newborns are rare, and we suggest that Mpox infection should be considered in the differential diagnosis of a neonatal vesicular rash, particularly if there is a history of similar rashes in the family.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19.

OBJECTIVE: To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. METHODS: A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation as ml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. RESULTS: There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. CONCLUSION: The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

OBJETIVO: Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. MéTODOS: Foi realizado um estudo retrospectivo em uma maternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foi medido em unidades de máscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. RESULTADOS: Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. CONCLUSãO: O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Alternative antimicrobials for prophylaxis of the Group B Streptococcus maternal-fetal disease.

INTRODUCTION: GBS colonization is an important risk factor for maternal and neonatal infection morbidity and mortality. Intrapartum antibiotics may prevent vertical transmission of GBS from colonized mothers to their babies. The objective of this study was to evaluate the effectiveness of cefazolin prophylactic regimen for GBS disease, comparing it to the established penicillin-based protocols, given the opportunity provided by the temporary unavailability of first-choice antibiotics in Brazil. METHODOLOGY: A retrospective analysis was conducted at the Hospital Femina Obstetrics Service between January and December 2015. Ninety-eight pregnant women received standard penicillin (70 patients) or ampicillin (28 patients) antibiotic prophylaxis, and 251 pregnant women received an alternative prophylaxis with cefazolin during the study period. Risk factor, Maternal and neonatal outcomes were evaluated and compared between groups. RESULTS: No significant difference was found in maternal (RR = 0.71; IC 95%:0.30-1.68; p = 0.709) and neonatal (RR = 0.84; IC 95%:0.61-1.15; p = 0.271) outcomes between those patients using the alternative antibiotic prophylaxis in comparison to the standard antibiotics, with the dependent variable of maternal and neonatal outcomes grouped and controlled for potential confounding variables. CONCLUSIONS: The antibiotics used as alternatives to penicillin and ampicillin for the prevention of maternal-fetal GBS disease are poorly studied, and this study indicate that cefazolin can be an optimal choice, offering safety in the use of this antibiotic in situations where penicillins are contraindicated or unavailable.

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

Abstract Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

Oral Desensitization to Penicillin for the Treatment of Pregnant Women with Syphilis: A Successful Program.

Gestational syphilis is a prevalent disease in Brazil and other low and medium income countries. Desensitization to penicillin is recommended for pregnant women with syphilis who are allergic to ß-lactams. This is a descriptive study utilizing outpatient medical records from 2011 to 2015 from a mother and child hospital that is part of the national healthcare system in the South of Brazil, which performs an average of 3,600 birth assistances per year. All cases of pregnant women with syphilis and presumptive diagnosis of ß-lactam allergy during the study period were included. The patients referred for desensitization originated from the hospital prenatal care service, as well as from municipal/state antenatal care services. Oral desensitization was performed in the obstetric emergency room, and adult and pediatric intensive care units were available at all times. Ten patients underwent desensitization during the period of study. Personal history of urticaria was the most common reaction that demanded desensitization. All patients tolerated the procedure well, and showed no adverse reactions. We report a successful program of oral desensitization. None of the patients presented adverse reactions or complications, a fact that corroborates the feasibility and safety of the desensitization protocol. Oral administration of penicillin comes at a low cost, and optimizes the use of time and resources.

A sífilis gestacional é uma doença prevalente no Brasil e em outros países de baixa e média renda. A dessensibilização à penicilina é recomendada para mulheres grávidas com sífilis que são alérgicas a ß-lactâmicos. Este é um estudo descritivo que utiliza registros médicos de 2011 a 2015 de um hospital público materno-fetal do Sul do Brasil com média de 3.600 partos anuais. Foram incluídos todos os casos de gestantes com sífilis e diagnóstico presuntivo de alergia a ß-lactâmicos durante o período de estudo. As pacientes encaminhadas para dessensibilização originaram-se do serviço pré-natal hospitalar internamente, bem como dos serviços municipais e estaduais de atendimento pré-natal. A dessensibilização oral foi realizada na sala de emergência obstétrica, e a unidade de terapia intensiva estava disponível em todos os momentos para o atendimento de possíveis intercorrências. Dez pacientes foram submetidas à dessensibilização durante o período estudado. História pessoal de urticária foi a reação mais comum que exigiu dessensibilização à penicilina. Todas as pacientes toleraram bem o procedimento, e não mostraram reações adversas. Relatamos no presente manuscrito um programa bem-sucedido de dessensibilização oral à penicilina. Nenhuma das pacientes apresentou reações adversas ou complicações, corroborando a viabilidade e segurança do protocolo de dessensibilização. A administração oral de penicilina tem baixo custo, e otimiza o uso de tempo e recursos para o tratamento adequado de sífilis gestacional no cenário apresentado.

Maternal syphilis and accomplishing sexual partner treatment: still a huge gap.

Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.

Surgical Site Infection after Cesarean Delivery in Times of COVID-19 / Infecção de sítio cirúrgico após cesariana em tempos de COVID-19

Abstract Objective To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. Methods A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation asml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. Results There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. Conclusion The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.

Resumo Objetivo Analisar os efeitos da pandemia de COVID-19 sobre o consumo de equipamentos e produtos de proteção individual (EPPI), assim como a frequência de infecção de sítio cirúrgico (ISC) em pacientes não infectadas por COVID-19 submetidas a cesarianas. Métodos Foi realizado umestudo retrospectivo em umamaternidade de um hospital público de ensino que não fazia parte do serviço de referência para o tratamento do COVID-19. Foram comparados o consumo de EPPI e a ocorrência de ISC após cesárea nos períodos mensais antes e após a ocorrência do primeiro caso de COVID-19 em Porto Alegre, RS, Brasil. O consumo de EPPI foimedido emunidades demáscaras, luvas, aventais e gorros, e o uso de produtos à base de álcool ou de sabonete para higienização das mãos em ml/paciente/dia. O índice SSI foi calculado como a proporção de casos de ISC sobre o número de cesarianas realizadas mensalmente durante o período do estudo. Resultados Houve aumento em todos os itens medidos do EPPI, com o consumo de máscaras descartáveis apresentando uma mediana de 1.450 no período pré-COVID e de 2550 no período pós-COVID (aumento de 75,9%). Detectou-se também diminuição de ISC, com medianas de 1,74 no período pré-COVID e de 0,89 no período pós-COVID, com redução de 49% no valor da mediana. Conclusão O aumento do consumo de EPPI pode ser resultado de práticas mais seguras adotadas pelos profissionais de saúde com o advento do COVID-19, do qual a redução na ocorrência de ISC pode ser uma consequência direta. Apesar da gravidade da crise, pode-se afirmar que situações extremas podem gerar reflexões valiosas e oportunidades de melhorias.

Characteristics of bacterial acute diarrhea among women.

OBJECTIVE: To describe the clinical and microbiological characteristics of women presenting with acute gastroenteritis due to infection with Salmonella spp. or Shigella spp. METHODS: A cross-sectional retrospective study was conducted using data for patients with specimens positive for Shigella spp. and Salmonella spp. attending two major women's hospitals in Porto Alegre, Brazil, between January 2003 and July 2014. Women were included if they had symptoms compatible with bacterial acute diarrhea. Isolates were evaluated to determine antimicrobial susceptibility and patient clinical profile. RESULTS: Among 45 eligible patients, Salmonella spp. was identified in 32 (71%) and Shigella spp. in 13 (29%). The highest antimicrobial sensitivity rates were observed for ciprofloxacin and ceftriaxone (n=44, 98% for both) whereas the greatest resistance rate was seen for ampicillin (n=20, 44%). Seven (16%) of the women were pregnant. CONCLUSION: Ciprofloxacin, ceftriaxone, and sulfamethoxazole/trimethoprim are suitable choices for the treatment of bacterial acute diarrhea. However, the maternal and fetal safety profile of prescribed medications should be considered when treating pregnant patients.

Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study.

UNLABELLED: The present study evaluated patients with diagnosis of surgical site infection (SSI) following cesarean section and their controls to determinate risk factors and impact of antibiotic prophylaxis on this condition. METHODS: All cesareans performed from January 2009 to December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control patients were determined after inclusion of case patients. Medical records of case and control patients were reviewed and compared regarding sociodemographic and clinical characteristics. RESULTS: Our study demonstrated an association following univariate analysis between post-cesarean SSI and number of internal vaginal examinations, time of membrane rupture, emergency cesarean and improper use of antibiotic prophylaxis. This same situation did not repeat itself in multivariate analysis with adjustment for risk factors, especially with regard to antibiotic prophylaxis, considering the emergency cesarean factor only. CONCLUSION: The authors of the present study not only question surgical antimicrobial prophylaxis use based on data presented here and in literature, but suggest that the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean section. Further research with greater number of patients and evaluated risk factors are fundamental for better understanding of the causes and evolution of surgical site infection after cesarean delivery.

[Microbial etiology and susceptibility of community urinary tract infections during pregnancy in the south of Brazil]. / Prevalência de uropatógenos e sensibilidade antimicrobiana em uroculturas de gestantes do Sul do Brasil.

PURPOSE: Urinary tract infection (UTI) is one of the most common conditions during pregnancy. The aim of this study was to assess the prevalence of germs and the antimicrobial susceptibility profile in urine culture isolates from pregnant patients treated at a tertiary maternity hospital in Porto Alegre, Brazil. METHODS: A cross-sectional, retrospective and descriptive study was carried out at Hospital Fêmina, a leading institution in prenatal, birth and postnatal healthcare in the city of Porto Alegre, Brazil. A total of 482 microbial community results were analyzed out of 1,558 positive urine cultures of pregnant women in all gestational ages treated at Fêmina Hospital between January 2007 and July 2013. RESULTS: The susceptibility pattern presented in this research shows that the choice for UTI treatment during pregnancy should be nitrofurantoin (for uncomplicated infections) or second-generation cephalosporins such as cefuroxime (for uncomplicated and complicated infections), over ampicillin, first-generation cephalosporins and sulfamethoxazole/trimethoprim. CONCLUSION: Empirical treatment for UTI in pregnancy should be started according to the susceptibility patterns described in the literature and re-analyzed after the results of the urine culture.

Post-cesarean surgical site infection due to Buttiauxella agrestis.

Surgical site infections (SSI) are postoperative complications that constitute a major public health problem. We present a rare case report of infection by Buttiauxella agrestis, a member of the Enterobacteriaceae family, occurring after a cesarean delivery in a young woman with no comorbidities. The authors further discuss the origin of this infection.

Oral desensitization to penicillin for the treatment of pregnant women with syphilis: A successful program / Dessensibilização oral à penicilina para o tratamento da sífilis na gestação: um exemplo de experiência bem-sucedida

Abstract Gestational syphilis is a prevalent disease in Brazil and other low and medium income countries. Desensitization to penicillin is recommended for pregnant women with syphilis who are allergic to β-lactams. This is a descriptive study utilizing outpatient medical records from 2011 to 2015 from a mother and child hospital that is part of the national healthcare system in the South of Brazil, which performs an average of 3,600 birth assistances per year. All cases of pregnant women with syphilis and presumptive diagnosis of β-lactam allergy during the study period were included. The patients referred for desensitization originated from the hospital prenatal care service, as well as from municipal/state antenatal care services. Oral desensitization was performed in the obstetric emergency room, and adult and pediatric intensive care units were available at all times. Ten patients underwent desensitization during the period of study. Personal history of urticaria was the most common reaction that demanded desensitization. All patients tolerated the procedure well, and showed no adverse reactions.We report a successful program of oral desensitization. None of the patients presented adverse reactions or complications, a fact that corroborates the feasibility and safety of the desensitization protocol. Oral administration of penicillin comes at a low cost, and optimizes the use of time and resources.

Resumo A sífilis gestacional é uma doença prevalente no Brasil e em outros países de baixa e média renda. A dessensibilização à penicilina é recomendada para mulheres grávidas com sífilis que são alérgicas a β-lactâmicos. Este é um estudo descritivo que utiliza registros médicos de 2011 a 2015 de um hospital público materno-fetal do Sul do Brasil com média de 3.600 partos anuais. Foram incluídos todos os casos de gestantes com sífilis e diagnóstico presuntivo de alergia a β-lactâmicos durante o período de estudo. As pacientes encaminhadas para dessensibilização originaram-se do serviço pré-natal hospitalar internamente, bem como dos serviços municipais e estaduais de atendimento pré-natal. A dessensibilização oral foi realizada na sala de emergência obstétrica, e a unidade de terapia intensiva estava disponível em todos os momentos para o atendimento de possíveis intercorrências. Dez pacientes foram submetidas à dessensibilização durante o período estudado. História pessoal de urticária foi a reação mais comum que exigiu dessensibilização à penicilina. Todas as pacientes toleraram bem o procedimento, e não mostraram reações adversas. Relatamos no presente manuscrito um programa bem-sucedido de dessensibilização oral à penicilina. Nenhuma das pacientes apresentou reações adversas ou complicações, corroborando a viabilidade e segurança do protocolo de dessensibilização. A administração oral de penicilina tem baixo custo, e otimiza o uso de tempo e recursos para o tratamento adequado de sífilis gestacional no cenário apresentado.

Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study

The present study evaluated patients with diagnosis of surgical site infection (SSI) following cesarean section and their controls to determinate risk factors and impact of antibiotic prophylaxis on this condition. Methods: All cesareans performed from January 2009 to December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control patients were determined after inclusion of case patients. Medical records of case and control patients were reviewed and compared regarding sociodemographic and clinical characteristics. Results: Our study demonstrated an association following univariate analysis between post-cesarean SSI and number of internal vaginal examinations, time of membrane rupture, emergency cesarean and improper use of antibiotic prophylaxis. This same situation did not repeat itself in multivariate analysis with adjustment for risk factors, especially with regard to antibiotic prophylaxis, considering the emergency cesarean factor only. Conclusion: The authors of the present study not only question surgical antimicrobial prophylaxis use based on data presented here and in literature, but suggest that the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean section. Further research with greater number of patients and evaluated risk factors are fundamental for better understanding of the causes and evolution of surgical site infection after cesarean delivery. .

Prevalência de uropatógenos e sensibilidade antimicrobiana em uroculturas de gestantes do Sul do Brasil / Microbial etiology and susceptibility of community urinary tract infections during pregnancy in the south of Brazil

OBJETIVO: O objetivo do estudo foi avaliar a prevalência de germes e do perfil de sensibilidade a antimicrobianos a partir de uroculturas de pacientes gestantes atendidas em um hospital materno-infantil em Porto Alegre, Brasil. MÉTODOS : Foi realizado estudo transversal, retrospectivo e descritivo, no Hospital Fêmina, referência para atendimento às mulheres durante o pré-natal, parto e puerpério na cidade de Porto Alegre, Brasil. A partir de 1.558 uroculturas positivas, foram avaliados 482 resultados microbiológicos comunitários com perfil de sensibilidade antimicrobiana de uroculturas de gestantes em todas as idades gestacionais, atendidas no período de janeiro de 2007 a julho de 2013. RESULTADOS : O padrão de sensibilidade apresentado nesta pesquisa mostra que a escolha para o tratamento de infecção urinária durante a gravidez deve ser nitrofurantoína (para infecções não complicadas) ou cefalosporinas de segunda geração, como cefuroxima (para infecções não complicadas e complicadas), evitando o uso de ampicilina, cefalosporinas de primeira geração e sulfametoxazol/trimetoprim. CONCLUSÃO : O tratamento empírico de infecção urinária na gravidez deve ser iniciado de acordo com os padrões de suscetibilidade descritos na literatura, e revisto após os resultados de cultura de urina. .

PURPOSE : Urinary tract infection (UTI) is one of the most common conditions during pregnancy. The aim of this study was to assess the prevalence of germs and the antimicrobial susceptibility profile in urine culture isolates from pregnant patients treated at a tertiary maternity hospital in Porto Alegre, Brazil. METHODS : A cross-sectional, retrospective and descriptive study was carried out at Hospital Fêmina, a leading institution in prenatal, birth and postnatal healthcare in the city of Porto Alegre, Brazil. A total of 482 microbial community results were analyzed out of 1,558 positive urine cultures of pregnant women in all gestational ages treated at Fêmina Hospital between January 2007 and July 2013. RESULTS: The susceptibility pattern presented in this research shows that the choice for UTI treatment during pregnancy should be nitrofurantoin (for uncomplicated infections) or second-generation cephalosporins such as cefuroxime (for uncomplicated and complicated infections), over ampicillin, first-generation cephalosporins and sulfamethoxazole/trimethoprim. CONCLUSION : Empirical treatment for UTI in pregnancy should be started according to the susceptibility patterns described in the literature and re-analyzed after the results of the urine culture. .

Diagnósticos de enfermagem identificados em pacientes hospitalizados durante sessões de hemodiálise / Nursing diagnoses identified in hospitalized patients during hemodialysis

OBJETIVO: Estabelecer os diagnósticos de enfermagem (DEs) de acordo com a NANDA International em pacientes hospitalizados com insuficiência renal crônica (IRC), submetidos a hemodiálise, a partir de fatores de risco e sinais e sintomas descritos em evoluções de enfermagem. MÉTODOS: Trata-se de um estudo de coorte retrospectivo, com amostra de 98 pacientes adultos hospitalizados com IRC e em sessões de hemodiálise. Os dados foram coletados retrospectivamente em prontuários e analisados estatísticamente. RESULTADOS: Foram identificados três DEs reais e quatro de risco: Volume de líquidos excessivo; Náusea; Dor aguda; Risco de infecção; Risco de glicemia instável; Risco de desequilíbrio eletrolítico e Risco de desequilíbrio do volume de líquidos. CONCLUSÃO: Estes DEs permitiram conhecer melhor os pacientes durante a sessão hemodialítica e assim, poderão subsidiar o cuidado de enfermagem.

OBJECTIVE: To establish NANDA International nursing diagnoses (NDs) in hospitalized patients with chronic renal failure (CRF), undergoing hemodialysis, using risk factors and signs and symptoms described in nursing developments. METHODS: This was a retrospective cohort study, with a sample of 98 hospitalized adult patients with CRF who were having hemodialysis. Data were collected retrospectively from medical records, and analyzed statistically. RESULTS: We identified three actual and four risk NDs: excess fluid volume, nausea, acute pain, risk for infection, risk for unstable blood glucose, risk for electrolyte imbalance, and risk for imbalanced fluid volume. CONCLUSION: These NDs enabled improved knowledge of the patients during the hemodialysis session, and therefore may be useful for nursing care.

OBJETIVO: Establecer los diagnósticos de enfermería (DEs) de acuerdo con la NANDA International en pacientes hospitalizados con insuficiencia renal crónica (IRC), sometidos a hemodiálisis, a partir de factores de riesgo y señales y síntomas descritos en evoluciones de enfermería. MÉTODOS: se trata de un estudio de cohorte retrospectivo, realizado con una muestra de 98 pacientes adultos hospitalizados con IRC y en sesiones de hemodiálisis. Los datos fueron recolectados retrospectivamente en historias clínicas y analizados estadísticamente. RESULTADOS: Se identificaron tres DEs reales y cuatro de riesgo: Volumen excesivo de líquidos; Náuseas; Dolor agudo; Riesgo de infección; Riesgo de glicemia inestable; Riesgo de desequilibrio electrolítico y Riesgo de desequilibrio del volumen de líquidos. CONCLUSIÓN: Estos DEs permitieron conocer mejor a los pacientes durante la sesión hemodialítica pudiendo subsidiar el cuidado de enfermería.

Infecção relacionada a cateter venoso central após a implementação de um conjunto de medidas preventivas (bundle) no centro de terapia intensiva (CTI) do Hospital de Clínicas de Porto Alegre / Central venous catheter-related infection after the implementation of a preventive bundle in intensive care unit (ICU) of Hospital de Clínicas de Porto Alegre

Introdução: As infecções de cateter venoso central (CVC) são um importante problema de saúde. Objetivo: Verificar a redução das taxas de infecção relacionadas a CVC no centro de terapia intensiva (CTI) adulto, através da implementação de um conjunto (bundle) de medidas preventivas utilizando a vigilância do processo de inserção e manutenção de CVCs. Método: Foi realizado um quase-experimento, no CTI adulto do Hospital de Clínicas de Porto Alegre (HCPA), antes e após a implementação dos bundles de inserção e manutenção de CVCs. Resultados: No bundle de inserção foram avaliados 594 procedimentos. A taxa de adesão ao bundle de inserção foi de 54,4%, e variou significativamente durante os meses do estudo. O uso de barreiras máximas foi a medida com menor adesão (54,0%). Em relação ao bundle de manutenção, a taxa de adesão no primeiro mês de implementação foi de 41,5%, e teve um aumento importante após o segundo mês devido à notificação nominal dos profissionais que não aderiam. A taxa média de infecção relacionada a CVC pré-intervenção foi de 2,4/1000 cateteres-dia e a média pós-intervenção foi de 1,2/1000 cateteres-dia. Nos períodos imediatamente antes e após a implementação dos bundles não se observou essa redução na taxa de infecções relacionada a CVC. Conclusão: Houve uma oscilação na taxa de adesão ao bundle de inserção, em contrapartida ocorreu uma melhora na adesão ao bundle de manutenção. A implementação de um bundle de prevenção é uma medida complexa, sendo importante o comprometimento de todos os profissionais envolvidos no cuidado aos pacientes.

Background: Central venous catheter (CVC) infections are an important health problem. Aims: Determine the rate of reduction of catheter-related blood stream infections in an adult intensive care unit (ICU) after the implementation of a bundle using preventive measures to monitor CVC insertion and maintenance. Method: We conducted a quasi-experiment in the adult ICU of Hospital de Clínicas de Porto Alegre (HCPA) before and after implementation of CVC insertion and maintenance bundles. Results: In the insertion bundle, 594 procedures were evaluated. The rate of adherence to the insertion bundle was 54.4% and fluctuated significantly during the months of the study. The use of full-barrier precautions was the component with the lowest adherence (54.0%). In the maintenance bundle, the rate of adherence in the first month of implementation was 41.5%, and there was a significant increase after the second month as a result of nominal reports addressed to uncooperative professionals. The mean rate of catheter-related blood stream infections pre-intervention was 2.4 per 1,000 catheter-days, and post-intervention, 1.2 per 1,000 catheter-days. There was no reduction in the rate of catheter-related blood stream infections immediately before and after implementation of the bundles. Conclusion: There were fluctuations in the rate of adherence to the insertion bundle, but there was an increase in adherence to the maintenance bundle. The implementation of a prevention bundle is a complex measure, and all professionals involved in patient care should be committed to it.

Avaliação do uso de cefazolina como profilaxia antibiótica em procedimentos cirúrgicos / Evaluation of cephazolin use as surgical-site infection prophylaxis in Hospital de Clínicas de Porto

Introdução: Infecções cirúrgicas são o segundo tipo mais frequente de infecção relacionada à assistência de saúde e tem sua incidência reduzida com a administração de antibioticoprofilaxia cirúrgica. Materiais e métodos: Foi realizado estudo transversal, de 01 de março a 30 de abril de 2010, observando-se a adequação do uso da cefazolina na profilaxia cirúrgica. A adequação foi avaliada conforme: 1. O tempo da primeira dose, 2. A dose utilizada, 3. Doses adicionais durante a cirurgia e 4. O tempo de manutenção do antimicrobiano após o procedimento. Resultados: Foram avaliadas 264 cirurgias com uso de cefazolina como antibioticoprofilaxia cirúrgica. Cirurgias limpas foram 85,6% da amostra, dessas 43,4% tinham implante de prótese. Todas as quatro etapas avaliadas estavam adequadas em 33,7% das cirurgias, e todas as etapas foram inadequadas em 2,3% das cirurgias. O tempo para a primeira dose estava correto em 66,3% dos procedimentos. Apenas um paciente teve administrada dose inadequada do antibiótico. Das cirurgias com mais de 3h de duração, em 46,5% foram realizadas doses adicionais da cefazolina. Quarenta e oito por cento dos pacientes receberam o antimicrobiano por mais de 24h. Em 6,1% destes pacientes foi feito o diagnóstico de infecção associada ao procedimento cirúrgico. Conclusão: Há uma baixa taxa de adequação da profilaxia cirúrgica com cefazolina no hospital. É necessária uma padronização desta profilaxia, com a instituição de um protocolo assistencial visando uniformizar as condutas para a prevenção da infecção de sítio cirúrgico no HCPA.

Aims: Surgical site infections are the second most frequent cause of healthcare associated infections, and their incidence is reduced with the administration of antimicrobial prophylaxis. Methods: This cross-sectional study, conducted from March 1 to April 30, 2010, evaluated adequacy and timeliness of cefazolin administration as surgical prophylaxis. Adequacy parameters were: (1) time to first dose; (2) cefazolin dose infused; (3) additional dose during surgery; and (4) duration of antimicrobial therapy after surgery. Results: Of a total of 264 surgeries evaluated, 85.6% were classified as clean, and prostheses were implanted in 43.4%. All steps of antimicrobial prophylaxis were adequate in 33.7% of the surgeries, and all steps were inadequate in 2.3%. Time to first dose was correct in 66.3% of the cases. Only one patient received an inadequate dose of the antimicrobial. Additional doses of cefazolin were administered in 46.5% of the surgeries that lasted more than 3 hours, and 48% of the patients received antimicrobial therapy for more than 24 hours. Surgical site infection was diagnosed in 6.1% of the patients. Conclusion: The rate of adequacy of surgical prophylaxis in the hospital was low. Standardized protocols and practices should be established to ensure adequate prevention of surgical site Infection in hospitals.