Multicentre surveillance of epidemiologically important pathogens causing nosocomial bloodstream infections and pneumonia trials in Brazilian adult intensive care units.

Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem.Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil.Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections.Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed.Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3 %, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3 %), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs.Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.

Associations between surgical wound infectious and clinical profile in patients undergoing cardiac surgery.

BACKGROUND: Infections are surgical severe adverse events that pose risks to patient safety in health services, in addition to increasing costs and morbidity and mortality. AIM: This study aims to describe the infectious profile of patients undergoing cardiac surgery and associate comorbidities and lifestyle habits with surgical wound infection. DESIGN: Observational and retrospective study. METHODS: The study included 453 patients undergoing cardiac surgery in a public teaching hospital from January 2014 to January 2019. Data were collected from the clinical records through an instrument composed of variables clinical characteristics, comorbidities, life habits, infection rates, infectious agents, clinical management and surgical wound features. Simple frequency, measures of central tendency and variability, Chi-Square test and logistic regression were used for data analysis. RESULTS: There was a predominance of hypertensive patients (367; 81%), smokers (107; 23.6%), alcoholics (76; 16.8%). Surgical wound infection affected 86 (19%) patients. Besides, most patients were under antibiotic therapy (310; 68.4%). Klebsiella pneumoniae; Staphylococcus epidermides and Staphylococcus aureus were the most frequent pathogens. Diabetes Mellitus, nephropathy and age were statistically significant (P<0.05) for higher risk of surgical wound infection. CONCLUSION: Chronic diseases and lifestyle habits were related to postoperative infection. More research is needed, focusing on risk factors for the development of surgical wound infection.

Pressure ulcers colonized by MRSA as a reservoir and risk for MRSA bacteremia in patients at a brazilian university hospital.

UNLABELLED: Pressure ulcers (PU) are a major reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. The objectives of this study were to estimate the prevalence of MRSA colonization in PU of hospitalized patients with Stage II or higher PU, to identify risk factors for colonization of these wounds, and to ascertain whether MRSA colonization of PU increases the risk of MRSA bacteremia. METHODS: This study was conducted at the Clinical Hospital of Federal University of Uberlandia, MG, Brazil. A prospective cohort study of 145 patients with Stage II or higher PU, colonized or not with MRSA, was conducted over 21 months. Infected ulcers were defined for clinical signs and for positive evaluation of smears of the wound by the ratio of polymorphonuclears to epithelial cells of ≥ 2:1, after Giemsa staining. RESULTS: Sixty-three (43.5%) MRSA colonized PU patients were identified, but none of the risk factors analyzed were independently associated with MRSA colonization. Among the patients with positive blood cultures and MRSA colonized PU, the odds ratio for MRSA bacteremia (OR = 19.0, 95% CI = 2.4-151.1, P < 0.001) and mortality rate (OR = 21.9, 95% CI = 1.23-391.5, P = 0.002), were high. Independent risk factors for MRSA bacteremia were: ≥ 2 underlying disease (OR = 6.26, 95% CI = 1.01-39.1, P = 0.05) and prior MRSA infected PU (OR = 12.75, 95% CI=1.22-132.9, P = 0.03). CONCLUSION: The present study identifies MRSA colonized PU patients as a potential epidemiologic reservoir for this organism and a high-risk for MRSA bacteremia, which contributes to prolonged hospitalization and poor prognosis. .