RESUMO
We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May-June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.
Assuntos
Antibacterianos , COVID-19 , Estado Terminal , Bactérias Gram-Negativas , Controle de Infecções , Padrões de Prática em Enfermagem , Superinfecção , Antibacterianos/classificação , Antibacterianos/uso terapêutico , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Maryland/epidemiologia , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/normas , Fatores Desencadeantes , Fatores de Risco , SARS-CoV-2 , Superinfecção/diagnóstico , Superinfecção/microbiologiaRESUMO
In this 2-phase real-world evaluation of chlorhexidine gluconate (CHG) skin concentrations in intensive care unit patients, we found lower skin CHG concentrations when rinsing with water after CHG solution bath (compared with no rinse), but no significant difference in concentrations between the use of CHG solution without rinse and preimpregnated CHG wipes. CHG concentration audits could be useful in assessing the quality of bathing practice, and CHG solution without rinsing may be an alternative to preimpregnated CHG wipes.
Assuntos
Banhos , Clorexidina/análogos & derivados , Cuidados Críticos , Unidades de Terapia Intensiva , Anti-Infecciosos Locais , Clorexidina/farmacologia , Infecção Hospitalar , Humanos , Controle de Infecções/métodos , Pele/microbiologia , Higiene da Pele/métodosRESUMO
OBJECTIVE: To identify factors associated with the development of surgical site infection (SSI) among adult patients undergoing renal transplantation DESIGN: A retrospective cohort study. SETTING: An urban tertiary care center in Baltimore, Maryland, with a well-established renal transplantation program that performs ~200-250 renal transplant procedures annually. RESULTS: At total of 441 adult patients underwent renal transplantation between January 1, 2010, and December 31, 2011. Of these 441 patients, 66 (15%) developed an SSI; of these 66, 31 (47%) were superficial incisional infections and 35 (53%) were deep-incisional or organ-space infections. The average body mass index (BMI) among this patient cohort was 29.7; 84 (42%) were obese (BMI >30). Patients who developed an SSI had a greater mean BMI (31.7 vs 29.4; P=.004) and were more likely to have a history of peripheral vascular disease, rheumatologic disease, and narcotic abuse. History of cerebral vascular disease was protective. Multivariate analysis showed BMI (odds ratio [OR] 1.06; 95% confidence interval [CI], 1.02-1.11) and past history of narcotic use/abuse (OR, 4.86; 95% CI, 1.24-19.12) to be significantly associated with development of SSI after controlling for National Healthcare Surveillance Network (NHSN) score and presence of cerebrovascular, peripheral vascular, and rheumatologic disease. CONCLUSIONS: We identified higher BMI as a risk factor for the development of SSI following renal transplantation. Notably, neither aggregate comorbidity scores nor NHSN risk index were associated with SSI in this population. Additional risk adjustment measures and research in this area are needed to compare SSIs across transplant centers.