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1.
MMWR Morb Mortal Wkly Rep ; 69(10): 260-264, 2020 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-32163381

RESUMEN

Since implementation of Standard Precautions* for the prevention of bloodborne pathogen transmission in 1985, health care-associated transmission of human immunodeficiency virus (HIV) in the United States has been rare (1). In October 2017, the New York City Department of Health and Mental Hygiene (NYCDOHMH) and the New York State Department of Health (NYSDOH) were notified by a clinician of a diagnosis of acute HIV infection in a young adult male (patient A) without recognized risk factors (i.e., he was monogamous, had an HIV-negative partner, and had no injection drug use) who had recently been hospitalized for a chronic medical condition. The low risk coupled with the recent hospitalization and medical procedures prompted NYSDOH, NYCDOHMH, and CDC to investigate this case as possible health care-associated transmission of HIV. Among persons with known HIV infection who had hospitalization dates overlapping those of patient A, one person (patient B) had an HIV strain highly similar to patient A's strain by nucleotide sequence analysis. The sequence relatedness, combined with other investigation findings, indicated a likely health care-associated transmission. Nucleotide sequence analysis, which is increasingly used for detecting HIV clusters (i.e., persons with closely related HIV strains) and to inform public health response (2,3), might also be used to identify possible health care-associated transmission of HIV to someone with health care exposure and no known HIV risk factors (4).


Asunto(s)
Infección Hospitalaria/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Análisis de Secuencia de ARN , Resultado Fatal , VIH-1/genética , VIH-2/genética , Hospitalización , Humanos , Masculino , New York , ARN Viral/genética , Insuficiencia Renal Crónica/terapia
2.
J Hosp Infect ; 104(3): 256-260, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138944

RESUMEN

One hundred years ago, many healthcare- associated infections (HAIs) had an exogenous origin, which means they were caused by micro-organisms from other patients, healthcare workers or the hospital environment. A smaller proportion was due to endogenous micro-organisms from the patients' own microbial flora. Meanwhile, many improvements have been achieved. The majority of devices used for diagnosing and treating the patients are now single- use items. The disinfection and sterilization measures used for reprocessing the remaining devices are on a very high safety level (at least in high-income countries) and cross- transmission via instruments is a very rare seldom event. Hand hygiene has also improved substantially. We have observed an increase in hand rub consumption of more than 100% during the last 12 years in Germany. For these measures the 'one size fits all approach' is appropriate because they have to be applied for all patients independent of their diseases and pathogens. Today, we see a small percentage of exogenous HAIs. The majority of HAI have an endogenous origin. Of course, it is still necessary to focus on basic or standard infection-control measures to prevent transmission of micro-organisms. However, the majority of HAIs have an endogenous origin now. Thus our measures should not only focus on preventing transmission of microorganisms, but also on prevention of infections. Therefore, a personalized infection prevention approach is now appropriate and examples will be presented.


Asunto(s)
Infección Hospitalaria/prevención & control , Higiene de las Manos , Control de Infecciones/métodos , Descontaminación , Humanos
3.
R I Med J (2013) ; 103(2): 21-23, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122095

RESUMEN

The rate of nosocomial C. difficile in the state of Rhode Island is among the highest in the country. Multiple factors impact the occurrence of nosocomial C. difficile. Improvement in a single factor may not lead to a decrease in the rate. We report the results of a multidisciplinary team that implemented multiple interventions, which led to a 42% reduction of nosocomial C. difficile at The Miriam Hospital.


Asunto(s)
Infecciones por Clostridium/prevención & control , Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Seguridad del Paciente , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/epidemiología , Hospitales , Humanos , Rhode Island/epidemiología
4.
R I Med J (2013) ; 103(2): 24-27, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122096

RESUMEN

C. difficile is a complication of antibiotic therapy. Certain antibiotics are associated with a higher rate of developing C. difficile. The charts of 54 patients with nosocomial C. difficile were reviewed and very few had received a high-risk antibiotic. Seven (13%) of 54 patients had not received any antibiotics in the hospital prior to the positive stool test for C. difficile. Moreover, 6 of the 7 had no documentation of receiving an antibiotic in the 56 days prior to admission suggesting that they might be colonized with C. difficile.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Clostridium difficile/efectos de los fármacos , Infección Hospitalaria/tratamiento farmacológico , Prescripción Inadecuada/efectos adversos , Pacientes Internos , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/microbiología , Femenino , Hospitales , Humanos , Incidencia , Pacientes Internos/estadística & datos numéricos , Tiempo de Internación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Rhode Island/epidemiología
5.
R I Med J (2013) ; 103(2): 28-30, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122097

RESUMEN

The rate of nosocomial C. difficile in Rhode Island is among the highest in the country. Colonization with C. difficile is uncommon but can lead to falsely identifying a patient as having C. difficile infection. Additionally, unrecognized C. difficile colonization may act as a reservoir in the hospital. During a 19-day period, rectal swabs obtained for routine VRE surveillance were cultured for C. difficile. Overall, 51 (7.9%) of 649 patients had C. difficile by culture. The majority (n=36, 71%) of patients from whom a rectal swab grew C. difficile did not have a sample sent to the clinical laboratory. Hence, at least 5.5% of the 649 patients were colonized. One patient was classified as having hospital-acquired C. difficile since the clinical specimen was sent to the clinical laboratory on hospital day 4. This patient was culture positive on admission and hence misclassified as having hospital- acquired C. difficile.


Asunto(s)
Infecciones por Clostridium/epidemiología , Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Pacientes Internos/estadística & datos numéricos , Adulto , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Hospitales , Humanos , Tiempo de Internación , Recto/microbiología , Rhode Island
6.
Br J Nurs ; 29(5): S28-S35, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32167812

RESUMEN

BACKGROUND: Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management. AIM: To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care. METHOD: A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised. FINDINGS: A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour. CONCLUSION: Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.


Asunto(s)
Infección Hospitalaria/prevención & control , Cicatrización de Heridas , Heridas y Traumatismos/enfermería , Heridas y Traumatismos/terapia , Humanos
7.
Br J Nurs ; 29(5): 290-296, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32167815

RESUMEN

Poor oral hygiene is an important risk factor for the development of non-ventilator hospital-associated pneumonia (NV-HAP), which imposes a significant burden on the NHS. This study aimed to establish whether the use of a 24-hour oral care kit and an oral care assessment tool can meet the needs of patients on an acute stroke unit. In comparison with the same period the preceding year, the introduction of the oral care kit and assessment tool improved compliance with oral care by more than 4 times; the overall costs of antibiotics to treat NV-HAP patients fell by 79%, with the number of doses falling by 70%, and the mortality rate decreased from 27% to 20%. According to a survey of multidisciplinary team (MDT) members keeping oral care tools available at the point of use saved time, and the oral health of patients on the unit improved after the introduction of the oral care kit and assessment tool. Almost all MDT members would recommend the use of the kit over previous interventions.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/prevención & control , Atención de Enfermería/métodos , Salud Bucal , Higiene Bucal/enfermería , Neumonía/prevención & control , Anciano , Cariostáticos/uso terapéutico , Femenino , Humanos , Masculino , Neumonía/epidemiología , Factores de Riesgo
8.
East Mediterr Health J ; 26(2): 198-205, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141598

RESUMEN

Background: Adequate hand hygiene is considered the most effective measure to reduce transmission of nosocomial pathogens. Aims: To determine the effectiveness of infection control intervention to improve compliance with hand hygiene in the Emergency Department, Al-Leith General Hospital, Saudi Arabia, and evaluate bacterial load on hands as a possible indicator of improvement. Methods: The study consisted of 3 phases: Phase I, measurement of basal hand hygiene compliance level; Phase II, multimodal hand hygiene educational programme was initiated; and Phase III, hand hygiene compliance level was measured again. Data were collected by direct observation of healthcare workers in the emergency department between October 2016 and March 2017, using the standardized World Health Organization method for direct observation, "Five Moments for Hand Hygiene". The intervention comprised health education sessions using direct personal contact. Hands of healthcare workers were sampled during Phases I and III by sterile bag method, and bacterial load was determined. Results: A total of 1374 opportunities for hand hygiene were observed during the triphase study. Implementation of the interventional hand hygiene educational programme significantly improved compliance with hand hygiene guidelines from 30.7% to 45.5% (P < 0.01). Log10 bacterial load per hand dropped from 4.97 (standard deviation = 0.32) to 4.57 (0.47) (P < 0.05). Conclusions: Hand hygiene educational programmes were effective in improving compliance in the emergency department, and bacterial load on hands of healthcare workers could be used as an indicator of improvement in hand hygiene compliance.


Asunto(s)
Infección Hospitalaria/prevención & control , Higiene de las Manos , Mano/microbiología , Personal de Salud , Control de Infecciones/métodos , Educación en Salud , Hospitales , Humanos , Unidades de Cuidados Intensivos/normas , Arabia Saudita
9.
Artículo en Inglés | MEDLINE | ID: mdl-32178604

RESUMEN

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2018 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin, and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,673 S. aureus bacteraemia episodes were reported, of which 78.9% were community-onset. A total of 17.4% of S. aureus isolates were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 17.1% which was not significantly higher than the 13.6% mortality associated with methicillin-susceptible SAB (p = 0.1). With the exception of the ß-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the ß-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin, 36% to ciprofloxacin and approximately 13% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). The ST22-IV [2B] (EMRSA-15) clone is the predominant healthcare-associated clone in Australia. Seventy-eight percent of methicillin-resistant SAB episodes in 2018 were due to community-associated clones. Although polyclonal, approximately 76.3% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST97-IV [2B]. Community-associated MRSA, in particular the ST45-VT [5C2&5] clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The ST45-VT [5C2&5] clone accounted for 11.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.


Asunto(s)
Antibacterianos , Staphylococcus aureus Resistente a Meticilina , Sepsis , Infecciones Estafilocócicas , Staphylococcus aureus , Antibacterianos/farmacología , Australia/epidemiología , Bacteriemia , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana/efectos de los fármacos , Humanos , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Sepsis/tratamiento farmacológico , Sepsis/etiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos
11.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 189-194, 2020 Mar 12.
Artículo en Chino | MEDLINE | ID: mdl-32164086

RESUMEN

Severe acute respiratory infection (SARI) diseases (such as SARS, MERS, pH1N1) can rapidly progress to acute respiratory failure with high lethality. The outbreak of a novel coronavirus infection can lead to 15%~ 30% patients developing into acute respiratory distress syndrome (ARDS). Respiratory support is the most important therapy for SARI patients with respiratory failure. However, respiratory support is a high skilled technology, which means inappropriate application may bring related complications and cross infection of SARI pathogens among medical staff and non-medical personnel in hospital. Therefore, it is meaningful to established a standardized indication of respiratory support and to prevent related nosocomial transmission in SARI patients.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infección Hospitalaria , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/terapia , Insuficiencia Respiratoria/terapia , Infección Hospitalaria/prevención & control , Humanos , Respiración Artificial , Síndrome de Dificultad Respiratoria del Adulto/virología , Insuficiencia Respiratoria/virología , Síndrome Respiratorio Agudo Grave/complicaciones
12.
J Epidemiol Glob Health ; 10(1): 1-3, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32175703

RESUMEN

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has plagued the Middle East since it was first reported in 2012. Recently, at the end of December 2019, a cluster of pneumonia cases were reported from Wuhan city, Hubei Province, China, linked to a wet seafood market with a new coronavirus identified as the etiologic agent currently named SARS-CoV-2. Most cases are in Mainland China with international spread to 25 countries. The novelty of the virus, the rapid national and international spread, and the lack of therapeutic and preventative strategies have led the WHO International Health Regulation emergency committee to declare the disease as Public Health Emergency of International Concern (PHEIC) on January 30, 2020. As it relates to countries with the ongoing MERS-CoV community cases and hospital acquired infections, there will be a huge challenge for HCWs to deal with both coronaviruses, especially with the lack of standardized and approved point of care testing. This challenge will now be faced by the whole global health community dealing with COVID-19 since both coronaviruses have similar presentation. Those patients should now be tested for both MERS-CoV and SARS-CoV-2 simultaneously, and with the continuing wide international spread of SARS-CoV-2, the travel history to China in the last 14 days will be of less significance.


Asunto(s)
Infecciones por Coronavirus , Brotes de Enfermedades , Salud Global , Neumonía Viral , China/epidemiología , Defensa Civil , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infección Hospitalaria , Humanos , Coronavirus del Síndrome Respiratorio de Oriente Medio , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Arabia Saudita/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Viaje
14.
Crit Care ; 24(1): 109, 2020 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-32188500

RESUMEN

BACKGROUND: Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. METHODS: This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. RESULTS: One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. DISCUSSION: While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). CONCLUSION: This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.


Asunto(s)
Antifúngicos/uso terapéutico , Candidemia/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Anciano , Estudios de Casos y Controles , Catéteres Venosos Centrales , Infección Hospitalaria , Femenino , Francia , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Suiza
15.
Crit Care ; 24(1): 110, 2020 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-32192532

RESUMEN

BACKGROUND: Decreased monocytic (m)HLA-DR expression is the most studied biomarker of sepsis-induced immunosuppression. To date, little is known about the relationship between sepsis characteristics, such as the site of infection, causative pathogen, or severity of disease, and mHLA-DR expression kinetics. METHODS: We evaluated mHLA-DR expression kinetics in 241 septic shock patients with different primary sites of infection and pathogens. Furthermore, we used unsupervised clustering analysis to identify mHLA-DR trajectories and evaluated their association with outcome parameters. RESULTS: No differences in mHLA-DR expression kinetics were found between groups of patients with different sites of infection (abdominal vs. respiratory, p = 0.13; abdominal vs. urinary tract, p = 0.53) and between pathogen categories (Gram-positive vs. Gram-negative, p = 0.54; Gram-positive vs. negative cultures, p = 0.84). The mHLA-DR expression kinetics differed between survivors and non-survivors (p < 0.001), with an increase over time in survivors only. Furthermore, we identified three mHLA-DR trajectories ('early improvers', 'delayed or non-improvers' and 'decliners'). The probability for adverse outcome (secondary infection or death) was higher in the delayed or non-improvers and decliners vs. the early improvers (delayed or non-improvers log-rank p = 0.03, adjusted hazard ratio 2.0 [95% CI 1.0-4.0], p = 0.057 and decliners log-rank p = 0.01, adjusted hazard ratio 2.8 [95% CI 1.1-7.1], p = 0.03). CONCLUSION: Sites of primary infection or causative pathogens are not associated with mHLA-DR expression kinetics in septic shock patients. However, patients showing delayed or no improvement in or a declining mHLA-DR expression have a higher risk for adverse outcome compared with patients exhibiting a swift increase in mHLA-DR expression. Our study signifies that changes in mHLA-DR expression over time, and not absolute values or static measurements, are of clinical importance in septic shock patients.


Asunto(s)
Antígenos HLA-DR/metabolismo , Choque Séptico/inmunología , Anciano , Anciano de 80 o más Años , Biomarcadores , Infección Hospitalaria , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Pronóstico , Factores de Riesgo , Choque Séptico/mortalidad
16.
Br J Nurs ; 29(3): S25-S29, 2020 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053448

RESUMEN

Demand for vascular access devices to meet the clinical needs of patients has increased dramatically in recent years, with a disproportionate increase in the numbers of individuals requiring a central venous access device (CVAD). With this increasing number of patients becoming recipients of CVADs globally each year, the associated incidence of catheter-related bloodstream infections (CRBSIs) is also increasing. In addition, there is strong evidence to demonstrate that antimicrobial resistance is a global challenge. There is a need to change the approach to CVAD management and get back to basics through a clearer understanding of how the incidence of CRBSIs can be reduced. This includes the role of biofilm and how its development can be inhibited through the use of an effective lock solution, and the avoidance of antibiotics.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Infección Hospitalaria/prevención & control , Biopelículas , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/epidemiología , Diseño de Equipo , Humanos , Incidencia
17.
Mil Med Res ; 7(1): 4, 2020 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-32029004

RESUMEN

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Infección Hospitalaria , Control de Infecciones , Tamizaje Masivo , Equipo de Protección Personal , Neumonía Viral , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/prevención & control , Diagnóstico Diferencial , Medicamentos Herbarios Chinos , Medicina Basada en la Evidencia , Fluidoterapia , Humanos , Control de Infecciones/normas , Pulmón/diagnóstico por imagen , Epidemiología Molecular , Atención de Enfermería , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/terapia , Neumonía Viral/transmisión
18.
Oral Health Prev Dent ; 18(1): 11-17, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32051966

RESUMEN

PURPOSE: To assess the relationship between periodontitis and nosocomial pneumonia in intensive care unit (ICU) patients. MATERIALS AND METHODS: The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD42018105124) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in five databases without restrictions regarding language or date of publication. From 560 studies selected, 10 underwent full-text analysis. Five studies were eligible (five case-control studies), and all were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). RESULTS: There was a significant association between periodontitis and nosocomial pneumonia in the meta-analysis (OR 2.55, 95% CI 1.68 to 3.86). In this meta-analysis, I2 = 0%. CONCLUSIONS: The evidence demonstrates a positive association between periodontitis and nosocomial pneumonia. Individuals with periodontitis admitted to the ICU were more likely to present nosocomial pneumonia than individuals without periodontitis.


Asunto(s)
Infección Hospitalaria , Periodontitis , Neumonía , Estudios de Casos y Controles , Humanos , Estudios Observacionales como Asunto
20.
Crit Care ; 24(1): 55, 2020 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-32066497

RESUMEN

BACKGROUND: Optimal antimicrobial drug exposure in the lung is required for successful treatment outcomes for nosocomial pneumonia. Little is known about the intrapulmonary pharmacokinetics (PK) of meropenem when administered by continuous infusion (CI). The aim of this study was to evaluate the PK of two dosages of meropenem (3 g vs 6 g/day by CI) in the plasma and epithelial lining fluid (ELF) in critically ill patients with nosocomial pneumonia. METHODS: Thirty-one patients (81% male, median (IQR) age 72 (22) years) were enrolled in a prospective, randomized, clinical trial. Sixteen patients received 1 g/8 h and 15 2 g/8 h by CI (8 h infusion). Plasma and ELF meropenem concentrations were modeled using a population methodology, and Monte Carlo simulations were performed to estimate the probability of attaining (PTA) a free ELF concentration of 50% of time above MIC (50% fT>MIC), which results in logarithmic killing and the suppression of resistance in experimental models of pneumonia. RESULTS: The median (IQR) of meropenem AUC0-24 h in the plasma and ELF was 287.6 (190.2) and 84.1 (78.8) mg h/L in the 1 g/8 h group vs 448.1 (231.8) and 163.0 (201.8) mg h/L in the 2 g/8 h group, respectively. The penetration ratio was approximately 30% and was comparable between the dosage groups. In the Monte Carlo simulations, only the highest approved dose of meropenem of 2 g/8 h by CI allowed to achieve an optimal PTA for all isolates with a MIC < 4 mg/L. CONCLUSIONS: An increase in the dose of meropenem administered by CI achieved a higher exposure in the plasma and ELF. The use of the highest licensed dose of 6 g/day may be necessary to achieve an optimal coverage in ELF for all susceptible isolates (MIC ≤ 2 mg/L) in patients with conserved renal function. An alternative therapy should be considered when the presence of microorganisms with a MIC greater than 2 mg/L is suspected. TRIAL REGISTRATION: The trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT-no. 2016-002796-10). Registered on 27 December 2016.


Asunto(s)
Antibacterianos , Infección Hospitalaria , Neumonía Asociada a la Atención Médica , Meropenem , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/farmacocinética , Infección Hospitalaria/tratamiento farmacológico , Femenino , Neumonía Asociada a la Atención Médica/tratamiento farmacológico , Humanos , Infusiones Intravenosas , Masculino , Meropenem/administración & dosificación , Meropenem/farmacocinética , Persona de Mediana Edad , Estudios Prospectivos
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