The impact of a bundle to prevent hospital-acquired pneumonia in a cohort of nonventilated patients on enteral nutrition.

We conducted a quasi-experimental study to evaluate a bundle to prevent nonventilator hospital-acquired pneumonia (NV-HAP) in patients on enteral tube feeding. After the intervention, there was an increase in bundle compliance from 55.9% to 70.5% (P < .01) and a significant decrease (34%) in overall NV-HAP rates from 5.71 to 3.77 of 1,000 admissions.

Surgical Site Infection Prevention Bundle in Cardiac Surgery / "Bundle" de Prevenção de Sítio Cirúrgico em Cirurgia Cardíaca

Abstract Background: Surgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2- to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks. Objective: The objective of this study was to identify SSI risk factors in clean cardiac surgery. Methods: A retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher's exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05. Results: The results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (OR: 2.575; CI: 1.224-5.416), obesity (OR: 2.068; CI: 1.457-2.936), diabetes mellitus (OR: 1,678; CI: 1.168-2.409), and blood glucose level (OR: 1.004; CI: 1.001-1.007). Conclusions: This study evidenced that complete adherence to the bundle was not associated with a reduction in the risk of surgical infections. Diabetes mellitus, obesity, and surgical risk index assessment were, however, identified to increase association and consequently risk of SSI in cardiac surgery.

Resumo Fundamento: As infecções de sítio cirúrgico (ISC) estão entre as mais prevalentes nas instituições de saúde, atribuindo um risco de morte, variando de 33 a 77%, sendo associado a um aumento de 2 a 11 vezes para o desfecho de óbito. Os pacientes submetidos à cirurgia cardíaca são mais suscetíveis às ISC´s, correspondendo entre as taxas de ISC´s de 3,5% a 21%, e a taxa de mortalidade atribuível a estas causas chegam a 25%. A prevenção de infecção de sítio cirúrgico em cirurgia cardíaca está baseada em medidas preventivas conhecidas como "bundle", focados nos fatores de risco modificáveis. Objetivos: O objetivo deste estudo foi identificar os fatores de risco para ISC´s em cirurgia cardíaca limpa. Métodos: Realizou-se um estudo retrospectivo de Coorte analisando 1846 prontuários de pacientes submetidos à cirurgia cardíaca limpa. Foi utilizado o teste exato de Fischer para a comparação bivariada e regressão de Poisson para análise independente de risco para infecção de sítio cirúrgico. Foi considerado o nível de significância p < 0,05. Resultados: O resultado do estudo compreendeu a uma análise multivariada, e as variáveis que se associaram com o diagnóstico de infecção de sítio cirúrgico foram: índice de risco cirúrgico (OR 2,575 IC 1,224-5,416), obesidade (OR 2,068 IC 1,457-2,936), diabete mellitus (OR 1,678 1,168-2,409); nível de glicemia (OR 1,004 IC 1,001-1,007). Conclusões: Foi evidenciado no estudo que a adesão completa ao "bundle" não se associou com a redução do risco de infecções cirúrgicas. Entretanto, foi identificado que o fato de ter diabetes mellitus, a obesidade e a avaliação através do índice de risco cirúrgico aumentam a associação e consequentemente ao risco de ISC em cirurgia cardíaca.

Surgical Site Infection Prevention Bundle in Cardiac Surgery.

BACKGROUND: Surgical site infections (SSI) are among the most prevalent infections in healthcare institutions, attributing a risk of death which varies from 33% to 77% and a 2- to 11-fold increase in risk of death. Patients submitted to cardiac surgery are more susceptible to SSI, accounting for 3.5% to 21% of SSI. The mortality rate attributable to these causes is as high as 25%. Prevention of SSI in cardiac surgery is based on a bundle of preventive measures, which focus on modifiable risks. OBJECTIVE: The objective of this study was to identify SSI risk factors in clean cardiac surgery. METHODS: A retrospective cohort study analyzed 1,846 medical records from patients who underwent clean cardiac surgery. Fisher's exact test was used for bivariate comparison, and Poisson regression was used for independent analysis of SSI risk, considering a significance level of p < 0.05. RESULTS: The results of the study comprised a multivariate analysis. The variables that were associated with the diagnosis of SSI were: surgical risk index (OR: 2.575; CI: 1.224-5.416), obesity (OR: 2.068; CI: 1.457-2.936), diabetes mellitus (OR: 1,678; CI: 1.168-2.409), and blood glucose level (OR: 1.004; CI: 1.001-1.007). CONCLUSIONS: This study evidenced that complete adherence to the bundle was not associated with a reduction in the risk of surgical infections. Diabetes mellitus, obesity, and surgical risk index assessment were, however, identified to increase association and consequently risk of SSI in cardiac surgery.

Acute cerebellitis caused by herpes simplex virus

Case presentation of acute cerebellitis caused by herpes simplex virus.

Serious infections among unselected patients with ST-elevation myocardial infarction treated with contemporary primary percutaneous coronary intervention.

BACKGROUND: Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce. METHODS: Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission. RESULTS: From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI. CONCLUSION: In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.

Community-acquired pneumonia at the Hospital de Clínicas de Porto Alegre: evaluation of a care protocol

To assess the adequacy of medical prescriptions for community-acquired pneumonia at the emergency department of the Hospital de Clínicas de Porto Alegre, we conducted a prospective cohort study, from January through April 2011. All patients with suspected pneumonia were selected from the first prescription of antimicrobials held in the emergency room. Patients with a description of pneumonia, community-acquired pneumonia, respiratory infection, or other issues related to community-acquired pneumonia were selected for review. Two-hundred and fifteen patients were studied. Adherence to the hospital care protocol was: 11.2% for the initial recommended tests (chest X-ray and collection of sputum sample), 34.4% for blood cultures, and 92.1% for the antimicrobial choice. Sixty percent of the prescriptions consisted of a combination of drugs, and the association of beta-lactam and macrolide was the most common. The Hospital Infection Control Committee evaluated patients' prescriptions within a median time of 23.5h (IQR 25-75%, 8-24). Negative evaluations accounted for 10% of prescriptions (n = 59). Fourteen percent of the patients died during hospitalization. In the multivariate analysis, Pneumonia Severity Index Score and use of ampicillin + sulbactam alone were independently related to in-hospital mortality. There was a high adherence to the hospital's CAP protocol, in relation to antimicrobial choice. Severity score and use of ampicillin + sulbactam alone were independently associated to in-hospital death.

Avaliação da limpeza terminal em uma unidade para pacientes portadores de microrganismos multirresistentes / Evaluation of terminal cleaning in an unit for patients with multidrugresistant organisms

INTRODUÇÃO: As infecções relacionadas à assistência à saúde são as complicações mais comuns a acometerem pacientes hospitalizados. O controle da disseminação de microrganismos de importância epidemiológica é um componente importante para a segurança do paciente.MÉTODOS: O estudo teve como objetivo avaliar a qualidade da limpeza terminalrealizada em leitos de uma unidade fechada para portadores de microrganismos multirresistentes. As limpezas foram avaliadas por meio de duas metodologias:inspeção visual por check list e detecção da presença de adenosina trifosfato(ATP). Foram avaliadas três superfícies próximas ao paciente: colchão, mesa de alimentação e mesa de cabeceira.RESULTADOS: Sessenta e seis leitos submetidos a limpeza terminal foram avaliados. Quinze leitos (23%) foram reprovados pela inspeção visual e 42 (66%)foram reprovados pela metodologia de detecção de ATP. As duas metodologias adotadas apresentaram baixa concordância nos resultados (kappa=0,235). As mesas de cabeceira e de alimentação apresentaram valores significantemente maiores de ATP quando comparadas aos colchões.CONCLUSÃO: As taxas de reprovação encontradas utilizando as duas metodologiasindicam que a prática hoje adotada na instituição pode ser aprimorada.

BACKGROUND: Health care acquired infections are the most common complicationsinvolving hospitalized patients. Controlling the spread of microorganisms of epidemiological importance is an essential component for patient safety.METHODS: This study aimed to evaluate the quality of terminal cleaning performed in a closed unit for patients with multidrug resistant organisms. Cleaning was evaluated using two methods: visual inspection (checklist) and adenosine triphosphate (ATP)bioluminescence assay. We evaluated three surfaces near the patient: mattress,feed table and bedside table.RESULTS: Sixty-six assessments were evaluated. Fifteen rooms (23%) were disapproved by visual inspection and 42 (66%) were disapproved by ATP detectionmethodology. The two methods used showed poor agreement of results (kappa =0.235). The bedside tables and feed tables showed significantly higher values ofATP when compared to mattresses.CONCLUSION: The cleaning failure rates found using the two different methodsindicate that the practice adopted in the institution can be improved.

Uso do balão intra-aórtico no trans e pós-operatório de cirurgia cardíaca: análise de 80 casos consecutivos / Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

FUNDAMENTO: A síndrome de baixo débito cardíaco no perioperatório de cirurgia cardíaca pode incidir em cerca de 10 a 15% dos pacientes; desse total, 2% necessitam de suporte mecânico para adequado controle hemodinâmico. OBJETIVOS: Descrever a mortalidade de pacientes que necessitaram utilizar balão intra-aórtico (BIAo) no trans ou pós-operatório de cirurgia cardíaca, identificando variáveis pré-operatórias associadas a pior desfecho, assim como descrever as complicações pós-operatórias e a sobrevida em médio prazo. MÉTODOS: Estudo de coorte retrospectivo incluindo 80 casos consecutivos entre janeiro/2009 e setembro/2011. Os pacientes possuíam, em média, 62,9 ± 11,3 anos e 58,8% eram do sexo masculino. Na amostra, 81,3% dos pacientes eram hipertensos, 50% tinham infarto do miocárdio prévio e 38,8%, insuficiência cardíaca NYHA III/IV. A principal cirurgia realizada foi a revascularização miocárdica isolada (37,5%). RESULTADOS:A mortalidade hospitalar nesta série foi de 53,8% (IC95%: 42,7-64,9), sendo o tempo de isquemia > 90 minutos preditor independente de mortalidade em análise multivariada (RR 1,52 IC95%: 1,04-2,22). Em relação às complicações, 71,3% (IC95%: 61,2-81,4) dos pacientes apresentaram ao menos uma complicação adicional no período perioperatório, sendo a isquemia do membro inferior observada em 5% dos pacientes. A sobrevida em 1 ano foi de 43,6%, observando-se um platô na curva de sobrevida após uma queda acentuada inicial, relacionada à mortalidade hospitalar. CONCLUSÕES: Os pacientes que necessitam do BIAo compõem um grupo de muito alto risco para morbidade e mortalidade; seu emprego, entretanto, permite recuperar muitos pacientes de uma evolução que seria invariavelmente fatal, tendo os pacientes com alta hospitalar uma boa sobrevida em médio prazo.

BACKGROUND: About 10% to 15% of patients undergoing cardiac surgery may develop low cardiac output syndrome in the perioperative period; of this total, 2% require mechanical support for adequate hemodynamic control. OBJECTIVE: To describe the mortality rates of patients who required the use of IABP in the perioperative or postoperative period of cardiac surgery, identifying preoperative variables associated with a worse outcome, as well as to describe the postoperative complications and medium-term survival. METHODS: Retrospective cohort study including 80 consecutive cases between January/2009 and September/ 2011. The patients had on average 62.9 ± 11.3 years and 58.8% were male; 81.3% were hypertensive, 50.0% had prior myocardial infarction and 38.8% has NYHA III/IV heart failure. The mainsurgery performed was isolated coronary artery bypass grafting (37.5%). RESULTS: Hospital mortality was 53.8% (IC 95%: 42.7-64.9), and cross-clamp time > 90 minutes was an independent predictor of mortality in multivariate analysis (OR 1.52 CI 95%: 1.04-2.22). 71.3% of patients (CI 95%: 61.2-81.4) had at least one additional complication in the perioperative period, with lower limb ischemia observed in 5.0% patients. One-year survival was 43.6%, with a plateau in survival rates after a sharp initial drop, related to hospital mortality. CONCLUSION: Patients who require IABP comprise a group of very high risk for morbidity and mortality. IABP use, however, enables the recovery of many patients from an evolution that would invariably be fatal, and patients discharged from hospital have a good medium-term survival.

Previous use of quinolones: a surrogate marker for first line anti-tuberculosis drugs resistance in HIV-infected patients?

OBJECTIVES: Drug resistant Mycobacterium tuberculosis causes much higher rates of treatment toxicity, failure or relapse, and mortality. We determined the drug resistant profile of Mycobacterium tuberculosis strains isolated from a population of HIV-infected patients in southern Brazil and studied the potential factors associated with resistance. METHODS: We conducted a retrospective cohort study to determine the resistance profile of Mycobacterium tuberculosis isolated from HIV-infected patients and factors that could be associated with resistance from 2000 to 2005. RESULTS: 236 patients were included in the study. Resistance to at least one drug was observed in 32 (14.6%) isolates, and multi-drug resistance was observed in 4 (1.82%) isolates. On multivariate analysis, previous use of tuberculostatics and quinolones were related to any first-line drug resistance. CONCLUSIONS: In our study, previous quinolone use was significantly associated to first-line anti-TB drugs resistance. Multi-drug-resistant tuberculosis (MDR-TB) is a major problem worldwide, and we believe quinolones should be used with caution in settings where TB is endemic.

Previous use of quinolones: a surrogate marker for first line anti-tuberculosis drugs resistance in HIV-infected patients?

OBJECTIVES: Drug resistant Mycobacterium tuberculosis causes much higher rates of treatment toxicity, failure or relapse, and mortality. We determined the drug resistant profile of Mycobacterium tuberculosis strains isolated from a population of HIV-infected patients in southern Brazil and studied the potential factors associated with resistance. METHODS: We conducted a retrospective cohort study to determine the resistance profile of Mycobacterium tuberculosis isolated from HIV-infected patients and factors that could be associated with resistance from 2000 to 2005. RESULTS: 236 patients were included in the study. Resistance to at least one drug was observed in 32 (14.6%) isolates, and multi-drug resistance was observed in 4 (1.82%) isolates. On multivariate analysis, previous use of tuberculostatics and quinolones were related to any first-line drug resistance. CONCLUSIONS: In our study, previous quinolone use was significantly associated to first-line anti-TB drugs resistance. Multi-drug-resistant tuberculosis (MDR-TB) is a major problem worldwide, and we believe quinolones should be used with caution in settings where TB is endemic.

Uma década de redução das infecções hospitalares no HCPA / A decade of reducing nosocomial infections in HCPA

O presente fascículo da Revista do HCPA traz três artigos abordando as infecções relacionadas à assistência à saúde no HCPA. No artigo de Benincasa e colaboradores [citar], as taxas de infecções puerperais relacionadas a parto cirúrgico (cesariana) e parto normal são analisadas através de série histórica compreendendo as taxas mensais observadas na instituição no período de janeiro de 2004 a dezembro de 2010. Segundo o estudo, as taxas de infecção puerperal relacionadas a partos normais são sustentadamente menores comparativamente àquelas observadas nos partos cirúrgicos. Ainda que o HCPA preste assistência pré-natal a gestantes de alto risco, apresenta não apenas a menor taxa de cesarianas entre os hospitais públicos e privados da cidade de Porto Alegre, como também observa progressiva redução nas taxas de infecção puerperal desde 2004.

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.

Microbiological findings in febrile neutropenic patients in a tertiary hospital of Southern Brazil / Achados microbiológicos em pacientes neutropênicos febris em um hospital terciário do sul do Brasil

Introdução: Neutropenia é um forte fator de risco para infecção. A prevalência de bactérias Gramnegativas diminuiu no início da década de 90 e a frequência de bactérias Gram-positivas aumentou em 55 a 70% em todos os episódios de bacteremia. Porém, mais recentemente, infecções por bactéria Gram-negativas ressurgiram. O objetivo deste estudo é descrever os achados microbiológicos em uma coorte de pacientes neutropênicos febris em um hospital terciário de ensino do sul do Brasil.Metodologia: Estudo coorte para avaliação da implementação de um protocolo clínico para o tratamento de pacientes neutropênicos febris. Foram incluídos prospectivamente pacientes com neutropenia febril (NF) admitidos entre janeiro de 2004 e dezembro de 2005 no Hospital de Clínicas de Porto Alegre. Controles históricos foram selecionados de visitas de pacientes entre março de 2001 e abril de 2003 ou antes do protocolo clínico ter sido implementado.Resultados: Nos períodos do estudo de 2004-2005 e 2001-2003, foram documentados 164 e 159 patógenos, respectivamente. Em 93 de 190 episódios (48,9%) e 84 de 193 episódios (43,5%) foram documentadas infecções microbiológicas.

Infecções fúngicas foram documentadas em poucos episódios (6,1 e 5,7%). Observou-se uma prevalência de 52,8% de bactérias Gram-positivas e 47,2% de bactérias Gram-negativas no período de 2001-2003. No período de 2004-2005, foram observadas 38,1% de bactérias Gram-positivas e 61,9% de bactérias Gram-negativas (P=0,012).Também houve um aumento significativo da prevalência de Pseudomonas aeruginosa no segundo período de estudo (1,9 para 11,6%; P<0,001). Em 2004-2005, seis isolados eram multirresistentes(31,6%). A prevalência de Staphylococcus resistente à oxacilina foi de 53,5 e 65,8% nos primeiros e segundos períodos, respectivamente (P=0,23).Conclusão: Os patógenos documentados neste estudo são os mais comuns em pacientes neutropênicos febris, mas a emergência de Pseudomonas aeruginosa resistente a multidrogas é uma preocupação.

Background: Neutropenia is a major risk factor for infection. The prevalence of Gram-negative bacteria decreased in the early nineties, while the frequency of Gram-positive bacteria increased from between 55 to 70% of all bacteremia episodes. Even more recently there has been a resurgence of Gram-negative infections. The aim of this report is to describe the microbiological findings in a cohort of febrile neutropenic patients in a tertiary teaching hospital of Southern Brazil.Methods: This was a cohort study designed to evaluate the implementation ofa clinical protocol for treatment of febrile neutropenic patients. Prospectively included in our study were patients with febrile neutropenia (FN) admitted between January 2004 and December 2005 at the Hospital de Clínicas of Porto Alegre.Historical controls were selected from patient visits recorded between March 2001 and April 2003 - or recorded before the clinical protocol was introduced.Results: During the 2004-2005 and 2001-2003 study periods, 164 and 159 pathogens were documented, respectively. In 93 of 190 episodes (48.9%), and 84 of 193 episodes (43.5%) there were documented microbiological infections. Fungal infection was documented in very few episodes (6.1 vs. 5.7%).

We also observed a 52.8% prevalence of Gram-positive and a 47.2% prevalence of Gram-negative bacteria in the 2001-2003 period. Observed in the 2004-2005 period were 38.1%Gram-positive and 61.9% Gram-negative bacteria (P=0.012). There was also a significant increase in Pseudomonas aeruginosa prevalence in the second study period (1.9 to 11.6%; P<0.001). Six isolates (31.6%) were discovered to be multiresistant in the 2004-2005 period versus none in the first period. The prevalence of Oxacillin-resistant Staphylococcus was 53.5 and 65.8% in the first and secondperiods, respectively (P=0.23).Conclusion: These documented pathogens are the most commonly observed in febrile neutropenic patients, but the emergence of multidrug-resistantPseudomonas aeruginosa is of some concern.