Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28
Filtrar
1.
Braz. j. infect. dis ; 18(1): 1-7, Jan-Feb/2014. tab
Artigo em Inglês | LILACS | ID: lil-703060

RESUMO

Background: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil. Methods: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load <50 copies/mL at week 48. Change in CD4 cell count was also evaluated. Outcome measures were analyzed on an intent-to-treat basis applied to observational studies. Sensitivity analysis was conducted to evaluate the impact of missing data at week 48. Predictors of virologic failure were examined using rare-event, finite sample, bias-corrected logistic regression. Results: Among 108 patients, the median age was 44.2 years, and 72.2% were male. They had long-standing HIV-1 infection (median 11.6 years) and advanced disease (76.9% had an AIDS-defining event). All patients had previously received protease inhibitors and nucleoside reverse transcriptase inhibitors, 75% nonnucleoside reverse transcriptase inhibitors, and 4.6% enfuvirtide. The median length of protease inhibitor use was 8.9 years, and 90.8% of patients had prior exposure to unboosted protease inhibitor. Genotypic resistance profile showed a median of three primary protease inhibitor mutations and 10.2% had three or more darunavir resistance-associated mutations. Virologic success at week 48 was achieved by 78.7% (95% CI = 69.7–86%) of patients and mean CD4 cell count increase from baseline was 131.5 cells/μL (95% CI = 103.4–159.6). In multiple logistic regression analysis, higher baseline viral load (RR = 1.04 per 10,000 copies/mL increase; 95% CI = 1.01–1.09) and higher number of darunavir resistance-associated mutations (RR = 1.23 per each; 95% CI = 0.95–1.48) ...


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Terapia de Salvação , Sulfonamidas/uso terapêutico , Brasil , Farmacorresistência Viral/genética , Genótipo , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1 , Estudos Retrospectivos , Carga Viral
2.
AIDS Res Hum Retroviruses ; 30(2): 113-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23875625

RESUMO

The effectiveness of switching from enfuvirtide to raltegravir in HIV-1-infected patients on a suppressive antiretroviral regimen has been poorly studied in the clinical practice of developing countries. We conducted a multicenter retrospective cohort study in HIV-1-infected, multidrug-experienced adults (≥18 years old) with plasma HIV-1-RNA <400 copies/ml for at least 4 months on an enfuvirtide-containing therapy between 2005 and 2010, in whom the attending physician switched from enfuvirtide to raltegravir. Effectiveness endpoints were measured at week 48 after switch. Analyses were conducted on an intent-to-treat basis and two strategies for handling missing outcome data were used (hereafter, strategies 1 and 2). Overall, 87 patients were eligible for analysis. At baseline, the median CD4(+) T cell count was 400 cells/µl and 91.9% of patients had <50 HIV-1-RNA copies/ml. At week 48, the proportions of patients with plasma HIV-1-RNA <50 and <400 copies/ml were, respectively, 86.2% (95% CI=77.1; 92.7%) and 88.5% (95% CI=79.9; 94.3%) (strategies 1 and 2) and 89.7% (95% CI=81.3; 95.2%) and 90.8% (95% CI=82.7; 95.9%) (strategies 1 and 2). This was a -10.3% (95% CI=-2.8; -17.9%) and -9.2% (95% CI=-2; -16.4%) difference from baseline in the proportion of patients with plasma HIV-1-RNA <400 copies/ml. The median increase in CD4(+) T cell counts was 41 and 64 cells/µl (p<0.001) (strategies 1 and 2). No patient withdrew raltegravir or developed opportunistic infections, but one was diagnosed with HIV-related dementia. In conclusion, switching from enfuvirtide to raltegravir in patients on a virologically suppressive regimen is an effective strategy even in a Brazilian clinical setting.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Proteína gp41 do Envelope de HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Fragmentos de Peptídeos/uso terapêutico , Pirrolidinonas/uso terapêutico , Adolescente , Adulto , Brasil , Contagem de Linfócito CD4 , Estudos de Coortes , Enfuvirtida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Raltegravir Potássico , Resultado do Tratamento , Carga Viral , Adulto Jovem
3.
J Int Assoc Provid AIDS Care ; 13(1): 63-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24134962

RESUMO

INTRODUCTION: Published data addressing the effectiveness of darunavir-ritonavir (DRV/r)-based therapy for multiexperienced patients in developing countries are scarce. This study evaluated the 48-week virologic and immunologic effectiveness of salvage therapy based on DRV/r for the treatment of multidrug-experienced HIV-1-infected adults in Brazil. MATERIALS AND METHODS: A multicenter retrospective cohort study was carried out with multidrug-experienced adults who were on a failing antiretroviral therapy and started a DRV/r-based salvage therapy between 2008 and 2010. The primary effectiveness end point was the proportion of patients with virologic success (plasma HIV-1 RNA <50 copies/mL at week 48). RESULTS: At 48 weeks, 73% of the patients had HIV-RNA <50 copies/mL and a mean increase of 108 CD4 cells/mm(3). Higher baseline viral load, lower baseline CD4 count, younger age, and 3 or more DRV/r-associated resistance mutations were significantly predictive of virologic failure. Concomitant use of raltegravir was strongly associated with virologic success. CONCLUSION: The use of DRV/r-based regimens for salvage therapy is an effective strategy in the clinical care setting of a developing country.


Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Brasil , Contagem de Linfócito CD4 , Estudos de Coortes , Darunavir , Farmacorresistência Viral , Feminino , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/genética , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carga Viral
4.
Braz J Infect Dis ; 18(1): 1-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23916454

RESUMO

BACKGROUND: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil. METHODS: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load<50 copies/mL at week 48. Change in CD4 cell count was also evaluated. Outcome measures were analyzed on an intent-to-treat basis applied to observational studies. Sensitivity analysis was conducted to evaluate the impact of missing data at week 48. Predictors of virologic failure were examined using rare-event, finite sample, bias-corrected logistic regression. RESULTS: Among 108 patients, the median age was 44.2 years, and 72.2% were male. They had long-standing HIV-1 infection (median 11.6 years) and advanced disease (76.9% had an AIDS-defining event). All patients had previously received protease inhibitors and nucleoside reverse transcriptase inhibitors, 75% nonnucleoside reverse transcriptase inhibitors, and 4.6% enfuvirtide. The median length of protease inhibitor use was 8.9 years, and 90.8% of patients had prior exposure to unboosted protease inhibitor. Genotypic resistance profile showed a median of three primary protease inhibitor mutations and 10.2% had three or more darunavir resistance-associated mutations. Virologic success at week 48 was achieved by 78.7% (95% CI=69.7-86%) of patients and mean CD4 cell count increase from baseline was 131.5 cells/µL (95% CI=103.4-159.6). In multiple logistic regression analysis, higher baseline viral load (RR=1.04 per 10,000 copies/mL increase; 95% CI=1.01-1.09) and higher number of darunavir resistance-associated mutations (RR=1.23 per each; 95% CI=0.95-1.48) were independently associated with virologic failure. CONCLUSION: Virologic suppression is a realistic endpoint for most treatment-experienced patients who begin a darunavir-based therapy outside the controlled conditions of a randomized trial, at routine care settings.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Terapia de Salvação , Sulfonamidas/uso terapêutico , Adulto , Brasil , Contagem de Linfócito CD4 , Darunavir , Farmacorresistência Viral/genética , Feminino , Genótipo , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carga Viral
5.
Cad. saúde pública ; 29(supl.1): s73-s80, Nov. 2013. tab
Artigo em Português | LILACS | ID: lil-690739

RESUMO

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.


Foi realizado estudo de coorte retrospectiva com o objetivo de avaliar o impacto do plano de cuidados do Programa de Atenção Domiciliar da Unimed-BH, modalidade Gerenciamento de Casos (PrGC/AD), sobre o tempo livre de hospitalização entre os pacientes com 60 anos ou mais assistidos pelo programa. Utilizou-se o modelo de Cox para avaliar o efeito do intervalo entre as visitas domiciliares dos profissionais do programa sobre o tempo livre de hospitalização de 2.943 idosos, ajustado por idade, medicamentos em uso, via de alimentação, úlcera de pressão, déficit cognitivo, dependência física, oxigenioterapia, consultas ambulatoriais e hospitalizações no trimestre anterior. Foram fatores de risco para menor tempo livre de hospitalização: o grau de dependência física, alimentação enteral, oxigenioterapia suplementar, úlceras de pressão e hospitalizações no trimestre anterior. Observouse efeito protetor dose-resposta da frequência de visitas médicas e de enfermagem. Os resultados sugerem que visitas domiciliares regulares de médico e enfermeiro aumentam significativamente o tempo livre de hospitalização nos pacientes assistidos pelo PrGC/AD.


Se realizó un estudio de cohorte retrospectivo para evaluar el impacto de un plan de asistencia del Programa de Atención Domiciliaria de Unimed-BH, modalidad de Gestión de Casos (PrGC/AD), sobre el tiempo libre de hospitalización en pacientes con 60 años o más. Se usó el modelo de riesgos proporcionales de Cox para evaluar el efecto del intervalo entre las visitas domiciliarias de los profesionales del programa sobre el tiempo libre de hospitalización de 2.943 ancianos, ajustado por edad, medicamentos usados, vía de alimentación, úlcera por presión, deterioro cognitivo, dependencia física, oxigenoterapia, consultas ambulatorias y hospitalizaciones en el trimestre anterior. Fueron factores de riesgo para un menor tiempo libre de hospitalización: grado de dependencia física, alimentación enteral, oxigenoterapia suplementaria, úlcera por presión y hospitalizaciones en el trimestre anterior. Las frecuencias de visitas médicas y de enfermeros tuvieron un efecto protector dosis-respuesta. Los resultados sugieren que las visitas domiciliarias regulares de médico y enfermero aumentan el tiempo libre de hospitalización en los pacientes asistidos por el PrGC/AD.


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Pré-Pagos de Saúde/normas , Serviços de Saúde para Idosos/normas , Serviços de Assistência Domiciliar/normas , Hospitalização/estatística & dados numéricos , Brasil , Estudos de Coortes , Serviços de Assistência Domiciliar/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo
6.
Cad Saude Publica ; 29 Suppl 1: S73-80, 2013 11.
Artigo em Português | MEDLINE | ID: mdl-25402253

RESUMO

A retrospective cohort study was performed to assess the impact of a Case Management Home Care Program supplied by the Unimed-BH medical cooperative on hospitalization-free survival time among eligible patients 60 years or older. A Cox proportional hazards model was fitted to assess the impact of home visits by health professionals on hospitalization-free survival time in a sample of 2,943 elders, while adjusting for patient age, physical dependence, medicines, feeding route, pressure ulcers, supplemental oxygen therapy, cognitive impairment, outpatient visits, and hospitalizations in the preceding quarter. Risk factors for shorter hospitalization-free survival time were: degree of physical dependence, enteral nutrition, supplemental oxygen therapy, pressure ulcers, and hospital admissions in the previous quarter. Higher rates of home visits by physicians and nurses showed a protective dose-response effect on hospitalization-free survival time. The data suggest that regular home visits by physicians and nurses lengthen hospitalization-free survival time among elderly patients enrolled in the program.


Assuntos
Sistemas Pré-Pagos de Saúde/normas , Serviços de Saúde para Idosos/normas , Serviços de Assistência Domiciliar/normas , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo
7.
Rev Soc Bras Med Trop ; 45(2): 147-50, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22534981

RESUMO

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antiprotozoários/uso terapêutico , Coinfecção/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Infecções por HIV/diagnóstico , Humanos , Masculino , Estudos Retrospectivos
8.
Rev. Soc. Bras. Med. Trop ; 45(2): 147-150, Mar.-Apr. 2012. tab
Artigo em Inglês | LILACS | ID: lil-625165

RESUMO

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.


INTRODUÇÃO: No Brasil, há uma grande área de sobreposição de leishmaniose visceral (LV) e infecção pelo HIV, o que favoreceu o aumento da incidência de co-infecção Leishmania/HIV. MÉTODOS: Este estudo avaliou a resposta clínica ao tratamento de 65 pacientes em dois centros de referência de saúde em Belo Horizonte, Brasil. RESULTADOS: O quadro clínico inicial foi semelhante entre os dois grupos, exceto pela maior frequência de diarréia e linfadenomegalia periférica em indivíduos infectados pelo HIV. Pacientes HIV-positivos apresentaram menor contagem de linfócitos no sangue (686/mm³versus 948/mm³p = 0,004) e menores valores de alanina aminotransferase (ALT) (48UI/L versus75,6UI/Lp = 0,016) do que pacientes HIV-negativos. Infecção pelo HIV-1 (hazard ratio-HR= 0,423, p = 0,023) e anemia (HR = 0,205, p = 0,002) foram preditores independentes de resposta clínica incompleta após o início do tratamento leishmanicida. CONCLUSÕES: Este estudo reforça a indicação de testagem para HIV em todos os pacientes diagnosticados com LV. O procedimento permitiria o reconhecimento precoce da co-infecção, levando à adequação do manejo clínico e o início da terapia antirretroviral, aumentando as chances de sucesso terapêutico.


Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antiprotozoários/uso terapêutico , Coinfecção/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Infecções por HIV/diagnóstico , Estudos Retrospectivos
9.
Infect Control Hosp Epidemiol ; 33(2): 124-34, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22227981

RESUMO

OBJECTIVE: To assess the benefit of using procedure-specific alternative cutoff points for National Nosocomial Infections Surveillance (NNIS) risk index variables and of extending surgical site infection (SSI) risk prediction models with a postdischarge surveillance indicator. DESIGN: Open, retrospective, validation cohort study. SETTING: Five private, nonuniversity Brazilian hospitals. PATIENTS: Consecutive inpatients operated on between January 1993 and May 2006 (other operations of the genitourinary system [n = 20,723], integumentary system [n = 12,408], or musculoskeletal system [n = 15,714] and abdominal hysterectomy [n = 11,847]). METHODS: For each procedure category, development and validation samples were defined nonrandomly. In the development samples, alternative SSI prognostic scores were constructed using logistic regression: (i) alternative NNIS scores used NNIS risk index covariates and cutoff points but locally derived SSI risk strata and rates, (ii) revised scores used procedure-specific alternative cutoff points, and (iii) extended scores expanded revised scores with a postdischarge surveillance indicator. Performances were compared in the validation samples using calibration, discrimination, and overall performance measures. RESULTS: The NNIS risk index showed low discrimination, inadequate calibration, and predictions with high variability. The most consistent advantage of alternative NNIS scores was regarding calibration (prevalence and dispersion components). Revised scores performed slightly better than the NNIS risk index for most procedures and measures, mainly in calibration. Extended scores clearly performed better than the NNIS risk index, irrespective of the measure or operative procedure. CONCLUSIONS: Locally derived SSI risk strata and rates improved the NNIS risk index's calibration. Alternative cutoff points further improved the specification of the intrinsic SSI risk component. Controlling for incomplete postdischarge SSI surveillance provided consistently more accurate SSI risk adjustment.


Assuntos
Infecção Hospitalar/epidemiologia , Hospitais Privados/normas , Controle de Infecções/normas , Vigilância da População , Risco Ajustado/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Brasil/epidemiologia , Estudos de Coortes , Infecção Hospitalar/prevenção & controle , Hospitais Privados/estatística & dados numéricos , Humanos , Modelos Logísticos , Estudos Retrospectivos , Risco Ajustado/normas , Infecção da Ferida Cirúrgica/prevenção & controle
10.
AIDS Res Hum Retroviruses ; 27(9): 981-7, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21361745

RESUMO

The emergence of resistance-associated mutations to the antiretroviral agents and the genetic variability of HIV-1 impose challenges to therapeutic success. We report the results of genotype testing assays performed between 2002 and 2006 in 240 antiretroviral-experienced patients followed up in an HIV reference center in Brazil. Drug resistance mutations and viral subtypes were assessed through the algorithms from the Brazilian Genotyping Network (RENAGENO-Brazil) and from Stanford University. Mutation 184VI was the most prevalent (70%) and the thymidine analogue mutations that appeared most frequently were 215FY, 41L, 67N, and 210W, in this order. Among nonnucleoside reverse transcriptase inhibitor mutations, 103NS (32.5%) stood out. HIV subtype B was identified in 184 patients (76.7%). A significant increasing trend in the prevalence of non-B subtypes was observed during the study period (p=0.004). The main differences in prevalence of mutations among HIV-1 subtypes were related to viral protease, with 20MRI, 36I, and 89IMT more prevalent among non-B subtypes, and 84V, 10FR, 63P, 71LTV, and 77I more common in subtype B (p<0.05). Most mutations to etravirine had a prevalence lower than 10%, but at least one mutation to this drug was observed in 45% of the patients. In only 11 patients (4.6%) three mutations to etravirine were verified. Regional surveillance of the resistance profile and HIV-1 subtypes is crucial in the context of public health, to prevent the transmission of resistant strains and to guide the introduction of new drugs in a specific population.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/genética , Mutação de Sentido Incorreto , Adulto , Idoso , Brasil/epidemiologia , Feminino , Genótipo , Infecções por HIV/tratamento farmacológico , HIV-1/classificação , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
11.
Infect Control Hosp Epidemiol ; 30(5): 433-9, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19301983

RESUMO

OBJECTIVE: We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index. DESIGN: Retrospective cohort study that used data prospectively collected from 1993 through 2006. SETTING: Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil. PATIENTS: Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies. METHODS: For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated. RESULTS: The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy. CONCLUSIONS: Compared with the NNIS-based model, the modified NNIS-based model added potentially useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.


Assuntos
Alta do Paciente , Vigilância da População/métodos , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Brasil , Infecção Hospitalar , Feminino , Humanos , Modelos Logísticos , Cuidados Pós-Operatórios/normas , Curva ROC , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/métodos , Infecção da Ferida Cirúrgica/prevenção & controle
12.
World J Gastrointest Surg ; 1(1): 11-5, 2009 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-21160789

RESUMO

With the introduction of quality assurance in health care delivery, there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities. Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs. Adverse post-operative events, and very especially surgical site infection (SSI) rates after specific procedures, gained popularity as hospital quality indicators in the 1980s. For a SSI rate to be considered a valid indicator of the quality of care, it is essential that a proper adjustment for patient case mix be performed, so that meaningful comparisons of SSI rates can be made among surgeons, institutions, or over time. So far, a significant impediment to developing meaningful hospital-acquired infection rates that can be used for intra- and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix. This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment, and identifies areas in which significant improvement is still needed.

14.
Infect Control Hosp Epidemiol ; 28(9): 1103-6, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17932836

RESUMO

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.


Assuntos
Colecistectomia Laparoscópica , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Entrevistas como Assunto , Laparotomia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Risco
15.
J Infect ; 55(4): 317-23, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17688950

RESUMO

OBJECTIVES: We assessed the contribution of the surgical approach and the NNIS system's surgical component variables to surgical site infection (SSI) risk after diagnostic exploration of the abdominal cavity. METHODS: Retrospective cohort study with prospective data collection (1993-2006) in five private, non-universitary, secondary or tertiary healthcare facilities. Outcome variable was SSI development within 30 days after surgery. Explanatory variables were age, gender, surgical approach (laparoscopic/open), elective/emergency/trauma procedure, hospital, surgeon, year, additional procedures, wound class, operation duration and ASA-PS score. RESULTS: Consecutive in-patients (6761) were included. Mean age was 38.1 (+/-14.1) years and 87.3% were female; 68% procedures were laparoscopic. Postdischarge follow-up was obtained for 57.7% patients. Patients operated on laparoscopically had reduced adjusted overall risk of SSI (OR=0.40, 95% CI=0.28-0.56), incisional infection (OR=0.43, 95% CI=0.29-0.62) and organ/space infection (OR=0.19, 95% CI=0.07-0.49). Older age, longer procedures, emergency or trauma procedures, medium- or high-risk surgeons and year

Assuntos
Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Cavidade Abdominal/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Braz J Infect Dis ; 11(2): 240-5, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17625770

RESUMO

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged <28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was <12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Proteína C-Reativa/análise , Sepse/tratamento farmacológico , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sepse/sangue , Sepse/microbiologia , Fatores de Tempo
17.
Am J Infect Control ; 35(3): 183-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17433942

RESUMO

BACKGROUND: We report on nosocomial infections (NIs), causative organisms, and antimicrobial susceptibility patterns in neonates who were admitted to neonatal intensive care units (NICUs), and assess the performance of birth weight (BW) as a variable for risk-stratified NI rate reporting. METHODS: A prospective, 10-year follow-up, open cohort study that involved six Brazilian NICUs was conducted. The NI incidence rates were calculated using different denominators. RESULTS: Six thousand two hundred forty-three newborns and 450 NICU-months of data were available for analysis. This included 3603 NIs that occurred in 2286 newborns over 121,008 patient-days. The most frequent NIs were primary bloodstream infection (pBSI; 45.9%), conjunctivitis (12.1%), skin infections (9.6%), and pneumonia (6.8%). Only the pBSI (but not pneumonia or central venous catheter-related pBSI) rate distribution differed significantly with varying BW. Gram-negative rods (mainly Klebsiella sp. and Escherichia coli) were responsible for 51.6% episodes of pBSI. Gram-positive organisms (mainly coagulase-positive staphylococci) accounted for 37.4%. Candida sp. was the fourth isolated organism. A high resistance to third-generation cephalosporins was recorded in K pneumoniae and E coli isolates. CONCLUSIONS: This report highlights the burden of NI, and identifies the major focus for future NI control and prevention programs. Except for pBSI, BW had a poor performance as a variable for risk-stratified NI rate reporting.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Vigilância da População , Bacteriemia/epidemiologia , Brasil/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/patogenicidade , Humanos , Recém-Nascido , Estudos Prospectivos
18.
Braz. j. infect. dis ; 11(2): 240-245, Apr. 2007. tab
Artigo em Inglês | LILACS | ID: lil-454741

RESUMO

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged <28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was <12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.


Assuntos
Humanos , Recém-Nascido , Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Proteína C-Reativa/análise , Sepse/tratamento farmacológico , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sepse/sangue , Sepse/microbiologia , Fatores de Tempo
19.
Medicina (B Aires) ; 66(5): 443-6, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-17137175

RESUMO

A 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. Ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. A puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of Staphylococcus aureus. Antimicrobial susceptibility testing by disk diffusion showed resistant to cefalotin, erythromycin and clindamycin, and susceptibility to trimethoprim-sulfamethoxazole, ciprofloxacin and rifampicin. Methicilin-resistance was confirmed by Staphyslide agglutination testing (Biomérieux). The patient was treated with ciprofloxacin and rifampicin during four weeks, with a good clinical response. The frequency of CA-MRSA infections is increasing, and these are reported in patients without identified predisposing risks leading to failure on empiric therapy for community infections presumed to be due to staphylococcal agents.


Assuntos
Resistência a Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/microbiologia , Abscesso/microbiologia , Adulto , Anti-Infecciosos/uso terapêutico , Ciprofloxacino/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Masculino , Rifampina/uso terapêutico , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus
20.
Enferm Infecc Microbiol Clin ; 24(7): 440-4, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-16956533

RESUMO

BACKGROUND: Trichinellosis is a parasitic zoonosis caused by ingestion of infected meat containing cysts of Trichinella spp. OBJECTIVES: To analyze the epidemiological, clinical and laboratory findings of trichinellosis patients in our center and compare the results with those from published series. To analyze the relationship between the clinical symptoms and laboratory findings. MATERIALS AND METHODS: The clinical records of 127 patients were retrospectively analyzed. RESULTS: Epidemiological: 61% were male and mean age was 32 years; 95% were associated with other cases. The food implicated was always pork. Clinical: 45% presented gastrointestinal symptoms and 98% systemic symptoms. Three patients required intensive care unit hospitalization and one died. In 53%, treatment consisted of associated antiparasitic and anti-inflammatory drugs. Laboratory: 59% presented leukocytosis and 72% absolute eosinophilia. Creatine phosphokinase was elevated in 62%, lactic dehydrogenase in 56% and glutamic-oxaloacetic transaminase (GOT) in 30%. Among 52 patients, 65% had positive serology; trichinoscopy of food samples was positive in three outbreaks. The population studied had a mean of 5 signs and/or symptoms. The patient group with more than 5 signs and/or symptoms presented higher white blood cell counts and GOT levels (p < 0.05) CONCLUSIONS: Our results were comparable to those of other series; however, there was a low rate of complications. An association was found between a larger number of signs and symptoms and higher leukocyte counts and GOT levels. The relevance of these findings should be assessed in future studies. There is no agreement as to the best therapeutic option, a fact reflected in the various treatment modalities seen in our study.


Assuntos
Trichinella/isolamento & purificação , Triquinelose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anticorpos Anti-Helmínticos/sangue , Antiparasitários/uso terapêutico , Argentina/epidemiologia , Análise Química do Sangue , Criança , Pré-Escolar , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trichinella/imunologia , Triquinelose/diagnóstico , Triquinelose/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA