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Int J Infect Dis ; 89: 179-184, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31580939


BACKGROUND: Limited data on healthcare-associated infections (HAIs) are available from the developing world, thus a point prevalence survey was conducted to determine the prevalence of HAIs and antimicrobial use in Guangdong Province, China. METHODS: A standardized methodology for point prevalence surveys on HAIs and antimicrobial use has been developed by the Chinese Nosocomial Infection Control and Quality Improvement Center. The prevalence of HAIs, antimicrobial use, and baseline hospital-level variables were collected in 189 hospitals from June 2017 to May 2018. RESULTS: Of 5 868 147 patients, 72 976 had one or more HAIs (1.24%), with 82 700 distinct HAIs. The prevalence rates of device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream infection were 7.92, 2.06, and 0.63 per 1000 catheter-days, respectively. A total of 10 591 (0.18%) HAIs caused by multidrug-resistant organisms were identified. Carbapenem non-susceptibility rates were highest in Acinetobacter species (53.86%) and Pseudomonas aeruginosa (21.60%). Forty-six percent (2 712 258/5 868 147) of inpatients were receiving at least one antimicrobial during this survey. CONCLUSIONS: This survey indicated the relatively lower prevalence of HAIs but higher antimicrobial using in Guangdong Province compared with other mid to low-income and high-income countries. Further studies are warranted to elucidate which HAI-related indicators are the best measures of HAI performance and thus allow improvements leading to better patient outcomes.

Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , China , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Estudos Transversais , Hospitais/estatística & dados numéricos , Humanos , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Prevalência , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
BMJ Open ; 7(9): e017761, 2017 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-28882927


OBJECTIVES: To determine the prevalence of sharp instrument injuries in hospital-based healthcare workers (HCWs) in mainland China and the contributing factors. DESIGN: Cross-sectional study. SETTING: The data were derived from public hospitals. PARTICIPANTS: A total of 360 hospitals were recruited in the study, including 289 general hospitals and 71 specialised hospitals. Among them, 194 are tertiary-level hospitals and 166 are secondary level. The study population finally consisted of 223 149 hospital HCWs. PRIMARY OUTCOME MEASURES: A questionnaire was designed based on the aim of the study. Profession of HCWs, workplace, circumstance and medical apparatus and instrument were covered in the survey. HCWs completed a self-administered questionnaire regarding details of sharp instrument injuries within the previous month. Prevalence estimates for the injuries were calculated for the overall HCWs and for subgroups according to profession, workplace, circumstance or instrument. RESULTS: Within the included HCWs, the prevalence of sharp instrument injuries was 0.08 per person-month. Only 4.6% of the HCWs reported to their hospitals after injury. The highest number of injuries occurred in nursing staff (10.3%). Injuries took place most frequently on general wards (44.5%). The circumstances that involved most frequent injuries include surgical needle insertion, removing an arteriovenous needle from a patient and recapping the needle. Single-use syringe caused more injuries incidents than other instruments. CONCLUSIONS: These results indicate that sharp instrument injuries have become a major occupational problem of HCWs in mainland China. Attentions need to be paid to the issue and strategies for preventing such injuries are needed.

Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Recursos Humanos em Hospital , China/epidemiologia , Estudos Transversais , Hospitais , Humanos , Prevalência , Autorrelato
Am J Infect Control ; 43(8): 810-5, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26234220


BACKGROUND AND OBJECTIVE: Observational studies have suggested an association between diabetes mellitus and the risk of surgical site infections (SSIs), but the results remain inconclusive. We conducted a meta-analysis of prospective cohort studies to elucidate the relationship between diabetes mellitus and SSIs. METHODS: We searched PubMed, Embase, and Web of Science databases and reviewed the reference lists of the retrieved articles to identify relevant studies. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The random-effect model was used to calculate the overall relative risk (RR). RESULTS: Fourteen prospective cohort studies (N = 91,094 participants) were included in this meta-analysis, and the pooled crude RR was 2.02 (95% confidence interval, 1.68-2.43) with significant between-study heterogeneity observed (I(2) = 56.50%). Significant association was also detected after we derived adjusted RRs for studies not reporting the adjusted RRs and calculated the combined adjusted RR of the 14 studies (RR, 1.69; 95% confidence interval, 1.33-2.13). Results were consistent and statistically significant in all subgroups. Stratified analyses found the number of confounders adjusted for, sample size, and method of diabetes case ascertainment might be the potential sources of heterogeneity. Sensitivity analysis further demonstrated the robustness of the result. CONCLUSIONS: This meta-analysis suggests diabetes mellitus is significantly associated with increased risk of SSIs. Future studies are encouraged to reveal the mechanisms underlying this association.

Complicações do Diabetes/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Estudos de Coortes , Humanos , Estudos Prospectivos , Medição de Risco
PLoS One ; 10(7): e0131602, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26146829


The serum 1,3-beta-D-glucan (BG) assay aids in the early diagnosis of invasive fungal diseases (IFDs) and has been approved for their diagnosis. However, reports on the screening performance of BG are scarce. We performed a meta-analysis of data extracted from only prospective cohort studies to evaluate the screening performance of the BG assay in the diagnosis of IFDs. We specifically searched 4 databases (the PubMed, Web of Science, Elsevier, and Cochrane Collaboration databases) according to EORTC-MSG criteria. A total of 1068 patients in 11 studies were analyzed. Deeks' funnel plot asymmetry test suggested a low likelihood of publication bias for the included studies (p = 0.055). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve, with 95% confidence intervals, were 0.75(0.63,0.84), 0.87(0.81,0.92), 5.85(3.96,8.63), 0.30(0.20,0.45), 19.53(11.16,34.18), and 0.89(0.86,0.91), respectively. The findings of this meta-analysis suggest that the BG assay is a useful screening tool with high sensitivity and specificity for discriminating between patients with and without IFDs. In clinical practice, BG assay results should be evaluated together with clinical and microbiological findings.

Micoses/diagnóstico , beta-Glucanas/sangue , Humanos , Micoses/sangue , Estudos Prospectivos , Sensibilidade e Especificidade
Pediatr Infect Dis J ; 31(10): e182-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22592515


OBJECTIVE: The aim of this study was to determine the accuracy of the procalcitonin (PCT) test for diagnosis of bacterial sepsis in pediatric cancer patients with febrile neutropenia. METHODS: Three major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies that evaluated the diagnostic value of PCT alone or compared with other laboratory markers such as C-reactive protein (CRP) to identify bacterial sepsis in children with fever and neutropenia. A bivariate model was used to derive summary sensitivity and specificity of the diagnostic tests. RESULTS: A total of 10 studies looking into PCT tests and 8 studies looking into CRP tests were included in the final analysis. The prevalence of bacterial sepsis was 304 of 1031 (29.5%) in PCT studies and 741 of 1316 (56.3%) in CRP studies. In terms of area under the receiver operating characteristic curve, PCT had comparable discrimination to CRP (area under the curve: 0.75 versus 0.74). PCT was not as sensitive as the CRP test. The pooled sensitivity of PCT was 0.59 (95% confidence interval [CI]: 0.42-0.74) as compared with 0.75 (95% CI: 0.61-0.85) for CRP. PCT was more specific than sensitive whereas CRP was more sensitive than specific in this population. The pooled specificity was 0.76 (95% CI: 0.64-0.85) for PCT and 0.62 (95% CI: 0.49-0.73) for CRP. PCT had greater likelihood ratio positive (2.50; 95% CI: 1.64-3.81), making it the better rule-in test. CONCLUSIONS: Of three markers potentially useful for diagnosing bacterial sepsis in children with fever and neutropenia, PCT had comparable diagnostic accuracy to CRP.

Bacteriemia/diagnóstico , Calcitonina/sangue , Febre de Causa Desconhecida/diagnóstico , Neutropenia/complicações , Precursores de Proteínas/sangue , Sepse/diagnóstico , Peptídeo Relacionado com Gene de Calcitonina , Humanos , Estatística como Assunto