[Precision medicine in infectious diseases]. / Präzisionsmedizin in der Infektiologie.

Infectious medicine faces a variety of challenges, such as the increase in antibiotic resistance and the emergence and spread of infectious diseases fueled by climate change and globalization. Precision medicine can provide solutions to many of these challenges. Since an untargeted request for diagnostic tests can lead to test results without clinical relevance, which can increase the use of non-indicated antibiotics, the principle aimed at is: targeted diagnostics (the right test) and consideration of patient characteristics (the right person) to optimize management (the right action). At the same time, one must always decide whether empirical therapy must be immediately initiated, even if the results of the initiated diagnostics are not yet available. In addition, many new diagnostics as well as therapies have recently been developed for the rapid detection and more specific treatment of bacterial infections. Molecular genetic methods, which offer more rapid results than classical bacterial cultures, are gaining ground as new diagnostics. New therapeutics such as bacteriophages, antibodies or antibacterial peptides allow increasingly precise treatment of certain bacterial infections. Precision medicine will also play an increasingly important role in infectious medicine in the future.

Reducing the duration of antibiotic therapy in surgical patients through a specific nationwide antimicrobial stewardship program. A prospective, interventional cohort study.

BACKGROUND: Guidelines recommend 5-7 days of antibiotic treatment in patients with surgical infection and adequate source control. This nationwide stewardship intervention aimed to reduce the duration of treatments in surgical patients to <7 days. METHODS: Prospective cohort study evaluating surgical patients receiving antibiotics ≥7 days in 32 hospitals. Indication for treatment, quality of source control, type of recommendations issued, and adherence to the recommendations were analysed. Temporal trends in the percentages of patients with treatment >7 days were evaluated using a linear regression model and Pearson's correlation coefficients. RESULTS: A total of 32 499 patients were included. Of these, 13.7% had treatments ≥7 days. In all, 3912 stewardship interventions were performed, primarily in general surgery (90.7%) and urology (8.1%). The main types of infection were intra-abdominal (73.4%), skin/soft tissues (9.8%) and urinary (9.2%). The septic focus was considered controlled in 59.9% of cases. Out of 5458 antibiotic prescriptions, the most frequently analysed drugs were piperacillin/tazobactam (21.7%), metronidazole (11.2%), amoxicillin/clavulanate (10.3%), meropenem (10.7%), ceftriaxone (9.3%) and ciprofloxacin (6.7%). The main recommendations issued were: treatment discontinuation (35.0%), maintenance (40.0%) or de-escalation (15.5%), and the overall adherence rate was 91.5%. With adequate source control, the most frequent recommendation was to terminate treatment (51.2%). Throughout the study period, a significant decrease in the percentage of prolonged treatments was observed (Pc=-0.69;P < 0.001). CONCLUSIONS: This stewardship programme reduced the duration of treatments in surgical departments. Preference was given to general surgery services, intra-abdominal infection, and beta-lactam antibiotics, including carbapenems. Adherence to the issued recommendations was high.

Decreasing Antibiotic Resistance Trends Nationally in Gram-Negative Bacteria Across United States Veterans Affairs Medical Centers, 2011-2020.

INTRODUCTION: Gram-negative resistance is a well-acknowledged public health threat. Surveillance data can be used to monitor resistance trends and identify strategies to mitigate their threat. The objective of this study was to assess antibiotic resistance trends in Gram-negative bacteria. METHODS: The first cultures of Pseudomonas aeruginosa, Citrobacter, Escherichia coli, Enterobacter, Klebsiella, Morganella morganii, Proteus mirabilis, and Serratia marcescens per hospitalized patient per month collected from 125 Veterans Affairs Medical Centers (VAMCs) between 2011 to 2020 were included. Time trends of resistance phenotypes (carbapenem, fluoroquinolone, extended-spectrum cephalosporin, multi-drug, and difficult-to-treat) were analyzed with Joinpoint regression to estimate average annual percent changes (AAPC) with 95% confidence intervals and p values. A 2020 antibiogram of reported antibiotic percent susceptibilities was also created to evaluate resistance rates at the beginning of the COVID-19 pandemic. RESULTS: Among 40 antimicrobial resistance phenotype trends assessed in 494,593 Gram-negative isolates, there were no noted increases; significant decreases were observed in 87.5% (n = 35), including in all P. aeruginosa, Citrobacter, Klebsiella, M. morganii, and S. marcescens phenotypes (p < 0.05). The largest decreases were seen in carbapenem-resistant phenotypes of P. mirabilis, Klebsiella, and M. morganii (AAPCs: - 22.9%, - 20.7%, and - 20.6%, respectively). In 2020, percent susceptibility was over 80% for all organisms tested against aminoglycosides, cefepime, ertapenem, meropenem, ceftazidime-avibactam, ceftolozane-tazobactam, and meropenem-vaborbactam. CONCLUSION: We observed significant decreases in antibiotic resistance for P. aeruginosa and Enterobacterales over the past decade. According to the 2020 antibiogram, in vitro antimicrobial activity was observed for most treatment options. These results may be related to the robust infection control and antimicrobial stewardship programs instituted nationally among VAMCs.

Resistencia antimicrobiana, una pandemia silenciosa / Antimicrobial resistance, a silent pandemic / Resistência antimicrobiana, uma pandemia silenciosa

Introducción: la resistencia a los antimicrobianos ha sido una problemática creciente a nivel global, la problemática afecta no solo la salud de personas, animales y el ambiente en general, sino que ha generado impactos de índole productivo y comercial. Una de las estrategias para abordar esta problemática es el enfoque de una salud. Este enfoque destaca la participación multidisciplinaria para combatir la resistencia antimicrobiana; y es así que cada profesión o actividad laboral genera unas responsabilidades innatas para la profesión veterinaria. Los veterinarios tienen un rol fundamental para este propósito, ya que son ellos quienes integran la aplicabilidad de estrategias de promoción y prevención a nivel agropecuario, y de consolidación e interlocución entre los diferentes componentes del enfoque (animal, humano, ambiente) desde el ámbito de la salud pública veterinaria. Materiales y Método: se realizó una búsqueda de la literatura en diferentes bases de datos, con el objetivo de realizar una revisión actualizada sobre la resistencia antimicrobiana. Resultados: dentro de las principales estrategias se debería fomentar un uso adecuado y bajo prescripción de antimicrobianos en la producción animal. Promover buenas prácticas de higiene, bioseguridad y vacunación, facilitando un correcto diagnóstico de enfermedades infecciosas en animales. Discusión: la adopción de normas internacionales para el uso responsable de los antibióticos y las directrices establecidas por la Organización Mundial de la Salud y Organización de las Naciones Unidas para la Alimentación y la Agricultura, a través del Codex Alimentarius y la Organización Mundial de Sanidad Animal, son fundamentales para hacer frente al desafío que representa el problema de la resistencia a los antimicrobianos.

Introduction: Antimicrobial resistance has been a growing problem at a global level, affecting not only the health of people, animals and the environment in general, but it has also generated impacts of a productive and commercial nature. One of the strategies to address this problem is the one-health approach. This approach emphasizes multidisciplinary participation to combat antimicrobial resistance; and thus, each profession or work activity generates innate responsibilities for the veterinary profession. Veterinarians have a fundamental role for this purpose, since they are the ones who integrate the applicability of promotion and prevention strategies at the agricultural level, and of consolidation and interlocution between the different components of the approach (animal, human, environment) from the field of veterinary public health. Materials and Method: a literature search was carried out in different databases, with the aim of carrying out an updated review on antimicrobial resistance. Results: one of the main strategies should be to promote an adequate use and under prescription of antimicrobials in animal production. Promote good hygiene, biosecurity and vaccination practices, facilitating a correct diagnosis of infectious diseases in animals. Discussion: the adoption of international standards for the responsible use of antibiotics and the guidelines established by the World Health Organization and the Food and Agriculture Organization of the United Nations, through Codex Alimentarius and the World Organization for Animal Health, are fundamental to face the challenge posed by the problem of antimicrobial resistance.

Introdução: A resistência antimicrobiana tem sido um problema crescente em todo o mundo, afetando não apenas a saúde dos seres humanos, dos animais e do meio ambiente em geral, mas também causando impactos na produção e no comércio. Uma das estratégias para lidar com esse problema é a abordagem One Health. Essa abordagem enfatiza o envolvimento multidisciplinar no combate à resistência antimicrobiana, com cada profissão ou atividade de trabalho gerando responsabilidades inatas à profissão veterinária. Os veterinários têm um papel fundamental nesse sentido, pois são eles que integram a aplicabilidade das estratégias de promoção e prevenção em nível agropecuário e de consolidação e interlocução entre os diferentes componentes da abordagem (animal, humano, ambiental) do campo da saúde pública veterinária. Materiais e Métodos: foi realizada uma pesquisa bibliográfica em diferentes bases de dados, com o objetivo de realizar uma revisão atualizada sobre a resistência antimicrobiana. Resultados: uma das principais estratégias deve ser a promoção do uso adequado e com baixa prescrição de antimicrobianos na produção animal. Promover boas práticas de higiene, biossegurança e vacinação, facilitando o diagnóstico correto de doenças infecciosas em animais. Discussão: A adoção de padrões internacionais para o uso responsável de antibióticos e as diretrizes estabelecidas pela Organização Mundial da Saúde e pela Organização das Nações Unidas para Agricultura e Alimentação, por meio do Codex Alimentarius e da Organização Mundial de Saúde Animal, são essenciais para enfrentar o desafio representado pelo problema da resistência antimicrobiana.

Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study.

BACKGROUND: Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital. METHODS: Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model. RESULTS: A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality. CONCLUSIONS: Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.

Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study.

BACKGROUND: Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea. METHODS: We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 university-affiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed. RESULTS: MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-term-care hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR gram-positive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15-1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%). CONCLUSION: Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospital-acquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.

Colonization with multidrug-resistant organisms is associated with impaired survival of patients with surgically resected cholangiocarcinoma.

BACKGROUND & AIMS: Colonization with multidrug-resistant organisms (MDRO) has been shown to impair survival in patients with various malignancies. Despite the increasing spread of MDRO, its impact on patients with cholangiocarcinoma (CCA) is unclear. Aim of this study was to analyse the impact of MDRO-colonization on overall prognosis in CCA patients. METHODS: All patients with surgically resected CCA diagnosed between August 2005 and November 2021 at the University Hospital Frankfurt were screened for MDRO. CCA patients with a positive MDRO screening before or within the first 90 days after diagnosis of CCA were defined as colonized. Patients with a negative MDRO screening were defined as non-colonized. RESULTS: Hundred and sixty nine patients were included. 32% (n = 54) were screened MDRO positive, while 68% (115) were non-colonized. Median overall survival (OS) for colonized patients was 17.1 months (95% CI = 9-25.2 months) compared to 50 months (95% CI = 37.1-62.8) for MDRO-negative patients (p ≤ .001). Non-cancer-related mortality (p ≤ .001) and infectious-related death (p ≤ .001) was significantly higher in the MDRO-colonized group. In multivariate analysis, MDRO colonization (HR = 2.1, 95% CI = 1.4-3.3, p = .001), ECOG 1 (HR = 2.5, 95% CI = 1.6-4, p ≤ .001) and N1 status (HR = 1.7, 95% CI = 1.1-2.6, p = .017) were independent risk factors for OS. CONCLUSION: MDRO-colonization contributes to poor survival in patients with surgically resected CCA. MDRO surveillance is necessary to optimize clinical management of infections and to potentially reduce mortality in this critical population.

Clinical characteristics and prognostic factors of patients with Klebsiella pneumoniae bloodstream infection / 中华全科医师杂志

Objective:To analyze the clinical characteristics, antibiotic resistance and prognostic risk factors of patients with Klebsiella pneumoniae bloodstream infection (Kp BSI).Methods:The clinical data of 188 patients diagnosed with Kp BSI from January 1，2017 to December 1，2021 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed.There were 118 patients males (62.8%) with a median age 77.0(63.0, 85.0) years old. The median length of hospital stay was 20.0 days, and 78 patients (41.5%) were admitted to intensive care unit(ICU). There were 121 cases with carbapenem-sensitive Klebsiella pneumoniae (64.4%, CSKP group) and 67 cases with carbapenem-resistant Klebsiella pneumoniae (35.6%, CRKP group).Fifty six patients died within 28 days after admission (death group), and 132 patients survived (survival group).The clinical characteristics and bacterial drug resistance of Kp BSI patients were analyzed, and univariate analysis and multivariate logistic regression analysis were used to explore factors related to the CRKP infection and patient mortality.Results:The most common infection sites were respiratory system, abdominal cavity and biliary tract accounting for 39.4% (74/188), 18.1% (34/188) and 14.4% (27/188), respectively.The common comorbidities were coronary heart disease, hypertension, chronic kidney disease and diabetes, accounting for 63.8% (120/188), 59.6% (112/188), 46.3% (87/188) and 43.1% (81/188), respectively and 118 patients (62.8%) had 3 or more comorbidities. Most patients (146 cases, 77.7%) underwent ≥1 invasive procedures before bloodstream infection;and 90 patients (47.9%) had a history of antibiotic use. CRKP strains showed higher resistance rates to piperacillin, quinolones, cephalosporins and carbapenems. Univariate analysis showed that there were statistically significant differences in age (69.0 vs. 83.0 years), ICU admission 25.6%(31/121) vs. 70.1%(47/67)], invasive procedures [67.8%(82/121) vs. 95.5 %(64/67)], and antibiotic use [37.2% (45/121) vs. 67.2%(45/67)] between the CSKP group and the CRKP group ( Z=-5.73, χ 2=35.22, χ 2=19.15, χ 2=15.53, all P<0.001). Multivariate logistic regression analysis showed that age, ICU admission, invasive procedures and antibiotic use in recent 30 days were independent risk factors for CRKP infection( OR=1.06, P<0.001; OR=3.22, P=0.003; OR=5.93, P=0.009; OR=2.40, P=0.022). The total fatality rate was 29.8%(56/188). Univariate analysis showed that there were statistically significant differences in CRKP infection [19.7%(26/132) vs. 73.2% (41/56)], albumin level (32.6 vs. 27.8 g/L) and sequential organ failure assessment score (SOFA score, 2 vs. 8 score) between the survival group and the death group (χ 2=49.10, Z=-4.64, Z=-10.36,all P<0.001). Multivariate logistic regression analysis suggested that CRKP infection, low albumin and high SOFA score on the day of bloodstream infection were risk factors for death of Kp BSI patients( OR=5.13, P=0.021; OR=0.86, P=0.044; OR=3.04, P<0.001). Conclusion:Kp BSI patients have a high fatality rate and fairly severe drug resistance. CRKP infection, low albumin, high SOFA score on the day of bloodstream infection are associated with poor prognosis in Kp BSI patients.

Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study

ABSTRACT Objective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. Conclusion The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.

Determinants of late neonatal nosocomial infection: a case-control study in Ceará / Determinantes de infecção nosocomial tardia neonatal: estudo de caso-controle no Ceará

ABSTRACT OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56-0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30-0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84-35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12-5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26-9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54-7.69); central venous catheters (OR = 10.00; 95%CI: 6.66-16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02-5.12); surgery (OR = 4.00; 95%CI: 2.27-7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83-17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26-2.68); central venous catheters (OR = 2.48; 95%CI: 1.40-4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

RESUMO OBJETIVO Identificar os fatores determinantes para infecções relacionadas à assistência à saúde (IRAS) tardias em terapia intensiva neonatal e multirresistência bacteriana. MÉTODOS Estudo caso-controle em unidade de terapia intensiva neonatal do Estado do Ceará, entre janeiro de 2013 e dezembro de 2017. Considerado caso o recém-nascido notificado como IRAS tardia e, controle, aquele sem infecção. Variáveis com valor de p ≤ 0,05 em análise regressiva bivariada inicial foram incluídas em modelo logístico hierarquizado não condicional para análise multivariada. Valores de p menores que 0,01 foram considerados significativos. RESULTADOS Dos 1.132 participantes, 427 (37,7%) tiveram infecções tardias relacionadas a assistência à saúde, com 54 (12,6%) hemoculturas positivas e 14,9% dessas foram bactérias multirresistentes. Na análise bivariada observou-se efeito protetor do sexo feminino (OR = 0,71; IC95% 0,56-0,90) e recém-nascido ≥ 34 semanas (OR = 0,48; IC95% 0,30-0,75). Nos mais prematuros, as infecções tardias tiveram chance dezoito vezes maior em menores do que 30 semanas (OR = 18,61; IC95% 9,84-35,22); e nos menores de 1.500g, quatro vezes maior (OR = 4,18; IC95% 3,12-5,61). O uso de ventilação mecânica aumentou em mais de sete vezes a chance (OR = 7,14; IC95% 5,26-9,09); o mesmo aconteceu com o recurso da nutrição parenteral (OR = 5,88; IC95% 4,54-7,69), com o cateter venoso central (OR = 10,00; IC95% 6,66-16,66); o número de cateteres utilizado (OR = 3,93; IC95% 3,02-5,12); a realização de cirurgia (OR = 4,00; IC95% 2,27-7,14) e o tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Permaneceram significativos após ajuste: prematuro menor do que 30 semanas (OR = 5,62; IC95% 1,83-17,28); uso de ventilação (OR = 1,84; IC95% 1,26-2,68); uso de cateter venoso central (OR = 2,48; IC95% 1,40-4,37) e tempo de internamento (OR = 1,06; IC95% 1,05-1,07). Dentre os óbitos, 41 (55,4%) foram associados às infecções tardias. CONCLUSÃO Melhores práticas devem ser adotadas no cuidado da prematuridade e o uso racional de procedimentos, para evitar infecções tardias relacionadas a assistência à saúde, óbitos preveníveis e riscos de multirresistência bacteriana e contaminação ambiental.

[Patient- and provider-related factors in the success of multidrug tuberculosis treatment in ColombiaFatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia]. / Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia.

OBJECTIVE: To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. METHODS: Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. RESULTS: Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. CONCLUSIONS: Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

OBJETIVO: Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. MÉTODOS: Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. RESULTADOS: Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. CONCLUSÕES: Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

[Treatment refractory multidrug-resistant bacterial keratitis]. / Therapierefraktäre 4-MRGN-Keratitis.

This article reports a case of severe, treatment refractory infectious keratitis. Multiple samples of the cornea and the anterior chamber were taken without detection of any pathogens. Ultimately a multidrug-resistant Pseudomonas aeruginosa was isolated and successfully treated with tobramycin and amikacin, according to its antibiotic sensitivity. If there is a clinical suspicion multiple samples should be taken and multidrug-resistant pathogens considered as a differential diagnosis.

Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia / Patient- and provider-related factors in the success of multidrug tuberculosis treatment in Colombia / Fatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia

RESUMEN Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.

ABSTRACT Objective. To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods. Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results. Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions. Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

RESUMO Objetivo. Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. Métodos. Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. Resultados. Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. Conclusões. Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

Effects of targeted surveillance combined with cluster management on isolation protector use rate and hand hygiene qualification rate in caregivers of patients with respiratory tract multidrug-resistant bacterial infections / 中国基层医药

Objective:To investigate the targeted surveillance combined with cluster management on isolation protector use rate and hand hygiene qualification rate in caregivers of patients with respiratory tract multidrug-resistant bacterial infections.Methods:Second Hospital of Shanxi Medical University began to perform targeted surveillance combined with cluster management among caregivers of patients with multidrug-resistant bacterial infections in July 2019. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted before targeted surveillance combined with cluster management were included in the pre-implementation group. The caregivers of 50 patients with respiratory tract multidrug-resistant bacterial infections who were admitted after targeted surveillance combined with cluster management were included in the post-implementation group. Multidrug-resistant bacterial infections in caregivers, isolation protector use rate, environmental disinfection and hand hygiene qualification rate were compared between before and after 6 months of targeted surveillance combined with cluster management. The application value of targeted surveillance combined with cluster management in the prevention of respiratory tract multidrug-resistant bacterial infections was analyzed.Results:The number of caregivers with respiratory tract multidrug-resistant bacterial infections in the post-implementation group was lower than that in the pre-implementation group (5 vs. 13, P < 0.05). The proportion of caregivers who wear a mask (94.11%), isolation clothes (80.39%) and gloves (98.03%) in the post-implementation group was significantly higher than that in the pre-implementation group (70.00%, 62.00%, 78.00%, χ2 = 10.027, 4.911, 9.683, all P < 0.05). The proportion of caregivers who were qualified in terms of hand hygiene (82.35%), object surface (76.47%), and keeping the air fresh in the post-implementation group was significantly higher than that in the pre-implementation group (64.00%, 58.00%, 64.00%, χ2 = 4.341, 3.915, 5.450, all P < 0.05). Conclusion:Targeted surveillance combined with cluster management can effectively help prevent respiratory tract multidrug-resistant bacterial infections in caregivers and increase isolation protector use rate and hand hygiene qualification rate.

Infecciones del Tracto Urinario: métodos diagnósticos, tratamiento empírico y multirresistencia en una Unidad de Adultos Área de Emergencias / Urinary Tract Infections: diagnostic methods, empirical treatment and multidrug resistance in an Adult Emergency Area Unit

INTRODUCCIÓN. Las infecciones del tracto urinario por variedad de bacterias uropatógenas multiresistentes se deben al uso de tratamiento empírico o automedicación. OBJETIVO. Describir en las infecciones de tracto urinario los métodos diagnósticos, tratamiento empírico y la multirresistencia. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población y muestra de 73 Historias Clínicas de pacientes atendidos en la Unidad de Adultos Área de Emergencias del Hospital de Especialidades Carlos Andrade Marín en el período enero a diciembre 2018. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnóstico clínico y por laboratorio de infección del tracto urinario superior e inferior. La información se obtuvo mediante la base de datos AS400, y se procesó en Epi-info y Excel. RESULTADOS. El 71,23% (52; 73) de mujeres tuvieron infección del tracto urinario. Escherichia coli fue frecuente en un 48,39% (15; 31), con mayor resistencia al Clotrimoxazol. El tratamiento empírico con Ciprofloxacino fue utilizado en 27,40% (20; 73). DISCUSIÓN: Se observó controversia en los tipos de estudios de imagen solicitados para el diagnóstico acorde a la clase de infección de tracto urinario así como el tratamiento empírico por factores propios de cada localidad que evitaron resistencia. CONCLUSIÓN. Escherichia coli se aisló de manera frecuente y registró mayor resistencia al Clotrimoxazol; el principal antibiótico prescrito como tratamiento empírico fue la Ciprofloxacina; el examen más solicitado fue la Urotomografía.

INTRODUCTION. Urinary tract infections due to a variety of multi-resistant uropathogenic bacteria are due to the use of empirical treatment or self-medication. OBJECTIVE. Describe diagnostic methods, empirical treatment and multidrug resistance in urinary tract infections. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population and sample of 73 Medical Records of patients treated in the Emergency Area Adult Unit of the Carlos Andrade Marín Specialty Hospital in the period january to december 2018. Patients older than 18 years of age, of both sexes, with clinical diagnosis and due to upper and lower urinary tract infection laboratory. The information was obtained through the AS400 database, and was processed in Epi-info and Excel. RESULTS. 71,23% (52; 73) of women had urinary tract infection. Escherichia coli was frequent in 48,39% (15; 31), with greater resistance to Clotrimoxazole. Empirical treatment with Ciprofloxacin was used in 27,40% (20; 73). DISCUSSION: Controversy was observed in the types of imaging studies requested for diagnosis according to the class of urinary tract infection as well as the empirical treatment due to factors specific to each locality that prevented resistance. CONCLUSION. Escherichia coli was frequently isolated and showed greater resistance to Clotrimoxazole; the main antibiotic prescribed as empirical treatment was Ciprofloxacin; the most requested examination was the Urotomography.

Hand Hygiene Practices, Attitudes, and Microbial Hand Populations of Practicing Doctors of Chiropractic.

OBJECTIVE: Hand hygiene practice is important in health care settings to reduce the spread of infection. To date, no hand hygiene study has been conducted with doctors of chiropractic that included microbiological analysis of hand specimens. The primary objective of this study was to examine the relationship between self-reported hand hygiene practices and attitudes of chiropractors with the number and type of pathogenic bacteria and yeast present on their hands. METHODS: In this cross-sectional study, a microbiological analysis of the chiropractor's dominant hand was performed along with completion of a survey concerning practices and attitudes regarding hand hygiene. The relationship between self-reported measures with laboratory findings was conducted using generalized linear modeling. RESULTS: Participants who responded to the survey indicated that hand hygiene was important, and most reported performing hand hygiene before and/or after patient contact. However, 7 (26.9%) participants had multidrug-resistant bacteria isolated from their hands. There was no correlation between the survey responses and hand specimens with the exception of the number of handwashing episodes. From the hand specimens, 16 (45.7%) coagulase-negative staphylococci isolates were oxacillin resistant, and 9 (25.7%) were multidrug resistant. CONCLUSION: This study found that like other health care workers, chiropractors had antimicrobial-resistant bacteria on their hands, some of which were multidrug resistant. Multidrug resistant bacteria have the potential to be transferred to patients and patient contact surfaces. These findings indicate that chiropractic offices could play a role in health care-associated infections. Formal hand hygiene training should be included as part of the chiropractic education curriculum and continuing education for doctors of chiropractic.

[The Age of Multidrug Resistance: Ten Year Incidence in a Neonatal Intensive Care Unit]. / A Era da Multirresistência: Incidência em Dez Anos Numa Unidade de Cuidados Intensivos Neonatais.

INTRODUCTION: The emergence of multidrug-resistant bacteria is a medical challenge nowadays. The objective of the present study was to determine the incidence of multidrug-resistant bacteria infections in a neonatal Intensive Care unit. MATERIAL AND METHODS: Retrospective, descriptive, incidence study of infectious episodes by multidrug-resistant bacteria from 2008 to 2017 in a differentiated perinatal support unit. RESULTS: Sixty-four infectious episodes included (median gestational age of 28 weeks and birth weight of 885 g). The isolated bacteria were: Enterobacteriaceae (n = 46); Methicillin-resistant Staphylococcus aureus (n = 12); Acinetobacter baumannii (n = 4); Pseudomonas aeruginosa (n = 2). A risk factor was identified in 90.6% of the episodes, with emphasis on central catheter (89%) and previous antibiotic therapy (78%). The lethality rate of these infections was 10.9% (Unit mortality rate: 4.4%). The overall incidence rate was 3.2 infectious episodes/100 hospitalizations, corresponding to 1.7 episodes/1000 days of hospitalization. There were three infectious outbreaks, with an increasing impact of Enterobacteriaceae. DISCUSSION: The reported incidence rate reflects a risk population, hospitalized in an Intensive Care unit, over a long period of time. The distribution of isolated bacteria, with Enterobacteriaceae predominance, is in accordance with the shift in multidrug resistance reported worldwide. The outbreaks point to the need of understanding risk factors and means of local dissemination. The relevance of these infections is evident in their lethality rate, which is higher compared to that of general hospital infections. CONCLUSION: The incidence rate reflects the local dimension of the problem, representing a quality indicator which is relevant for controlling these infections.

Introdução: A emergência de bactérias multirresistentes constitui um desafio médico na atualidade. O objetivo do presente estudo foi determinar a incidência das infeções por bactérias multirresistentes numa unidade de Cuidados Intensivos Neonatais. Material e Métodos: Estudo de incidência, retrospetivo, descritivo dos episódios infeciosos por bactérias multirresistentes, de 2008 a 2017, numa unidade de apoio perinatal diferenciado. Resultados: Incluíram-se 64 episódios infeciosos (medianas - idade gestacional: 28 semanas; peso ao nascimento: 885 g). As bactérias isoladas foram: Enterobacteriaceae (n = 46); Staphylococcus aureus meticilino-resistente (n = 12); Acinetobacter baumannii (n = 4); Pseudomonas aeruginosa (n = 2). Identificou-se um fator de risco em 90,6% dos episódios, destacando-se cateter central (89%) e antibioticoterapia prévia (78%). A taxa de letalidade associada foi 10,9% (taxa de mortalidade unidade: 4,4%). A incidência global foi 3,2 episódios infeciosos/100 internamentos, correspondentes a 1,7 episódios/1000 dias de internamento. Verificaram-se três surtos infeciosos com impacto crescente de Enterobacteriaceae.Discussão: A taxa de incidência descrita reflete uma população de risco, internada numa unidade de Cuidados Intensivos e num período longo de tempo. A distribuição das bactérias isoladas evidencia a evolução da multirresistência relatada internacionalmente, com predomínio crescente de Enterobacteriaceae. A ocorrência de surtos aponta para a necessidade de perceber fatores de risco e meios de disseminação local. A relevância destas infeções está patente na taxa letalidade, superior às infeções hospitalares em geral. Conclusão: A taxa de incidência reflete a dimensão local do problema, constituindo um indicador de qualidade, relevante para o controlo destas infeções.

Hospital-Acquired Pneumonia in a Multipurpose Intensive Care Unit: One-Year Prospective Study.

INTRODUCTION: Hospital-acquired pneumonia continues to be a frequent complication in the intensive care unit and an important cause of admission in the intensive care unit. The aim of our study was to evaluate the demography, incidence, risk factors, causative bacterial pathogens and outcome of all episodes of Hospital-acquired pneumonia in our unit. MATERIAL AND METHODS: Prospective observational study, at a tertiary university hospital during one year (2014) including all the cases of hospital-acquired pneumonia in the intensive care unit. RESULTS: Sixty patients were identified with pneumonia. Thirty-five (58.3%) had an intensive care unit acquired pneumonia, corresponding to 6.9 cases/1000 intubation-days. Antibiotic treatment in the previous 30 days was present in 75% of the cases. The incidence of Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii was 26.2%, 20.0% and 9.2%, respectively. Patients with late-onset hospital-acquired pneumonia (≥ 7 days) showed higher frequency of non-fermenting Gram-negative bacilli isolates, and methicillin-resistant S. aureus. Combination therapy was performed in 67.0%, and de-escalation in 18.3%. The mortality rate was 18.3%. The adjusted odds ratio for intensive care unit mortality in the group of patients with non-intensive care unit acquired pneumonia was 5.2 (95% CI of 1.02 - 22.10; p = 0.046). DISCUSSION: The knowledge of local bacterial flora and resistance patterns is of crucial importance and strongly recommended. This evidence increases the probability of success of empiric antibiotic therapy. CONCLUSION: S. aureus was the predominant causative agent of nosocomial pneumonia. The most frequent risk factor identified for infection with multidrug-resistant organisms was previous treatment with antibiotics. Multidrug-resistant organisms were present in 45% of documented hospital-acquired pneumonias. In admitted patients with non-intensive care unit acquired pneumonia, the intensive care unit mortality rate was nearly five times higher compared to intensive care unit acquired pneumonia.

Introdução: A pneumonia adquirida no hospital é uma complicação frequente nos doentes críticos e uma importante causa de admissão nos Cuidados Intensivos. O objetivo deste estudo foi avaliar a demografia, incidência, fatores de risco, microbiologia e outcome da pneumonia nosocomial num Serviço de Medicina Intensiva. Material e Métodos: Estudo prospectivo e observacional, num hospital universitário terciário, durante o período de um ano (2014). Resultados: Foram avaliados 60 doentes. Trinta e cinco (58,3%) com pneumonia nosocomial adquirida no Serviço de Medicina Intensiva, correspondendo a 6,9 casos/1000 dias de intubação. A antibioterapia nos últimos 30 dias esteve presente em 75% dos casos. A incidência de Staphylococcus aureus, Pseudomonas aeruginosa e Acinetobacter baumannii foi de 26,2%, 20,0% e 9,2% respetivamente. Os doentes com pneumonia de início tardio (≥ 7 dias) apresentaram maior frequência de bacilos Gram-negativos não-fermentadores e S. aureus resistente à meticilina. A antibioterapia em associação foi aplicada em 67,0% e a descalação em 18,3% dos doentes. A taxa de mortalidade foi 18,3%. O odds ratio ajustado de mortalidade no grupo de doentes críticos com pneumonia nosocomial adquirida fora da UCI foi de 5,2 (95% CI de 1,02 ­ 22,10; p = 0,046). Discussão: O conhecimento da flora local bacteriana e os padrões de resistência bacteriana são de grande importância e amplamente recomendados. Esta evidência aumenta a probabilidade de sucesso da antibioterapia empírica. Conclusão: O S. aureus foi o agente causador predominante da pneumonia. O fator de risco mais frequente para infecção por organismos multirresistentes foi o tratamento prévio com antibióticos. Organismos multirresistentes estavam presentes em 45% das pneumonias adquiridas no hospital de origem bacteriana comprovada. O grupo de doentes críticos com pneumonia nosocomial não adquirida no Serviço de Medicina Intensiva apresentou um risco de mortalidade cerca de cinco vezes maior comparativamente aos doentes com pneumonia nosocomial adquirida no Serviço de Medicina Intensiva.

[Antimicrobial Susceptibility Patterns in Outpatient Urinary Tract Infection in the District of Coimbra, Portugal: A Cross-Sectional Study]. / Perfil de Sensibilidade aos Antibióticos na Infeção Urinária em Ambulatório no Distrito de Coimbra: Um Estudo Transversal.

INTRODUCTION: Urinary tract infections in the community setting are quite common. It is necessary to be aware of antibiotic susceptibility patterns in order to provide rational empirical therapy. The aim of this study is to determine the frequency and antimicrobial susceptibility of the strains responsible for urinary tract infections in primary health care, in the district of Coimbra, Portugal. MATERIAL AND METHODS: In this observational and cross-sectional study, we analyzed 7134 positive urine cultures of outpatient laboratories in the district of Coimbra, over one year. In most cases, a positive culture was defined by a threshold of 105 colony-forming units per milliliter and was conducted by the automated system VITEK® 2, by bioMérieux. We used descriptive and inferential statistics to determine the prevalence and antimicrobial susceptibility of bacteria and to ascertain whether there were differences associated with sex and age. RESULTS: From the total of positive cultures, 83.4% pertained to females and 41.0% to individuals over 75 years old. Escherichia coli was the most frequent strain (63.9%), although its prevalence was lower (p < 0.001) in males and individuals over 75 years old. Its susceptibility to fosfomycin and nitrofurantoin was higher than 95% and with ciprofloxacin and trimethoprim/sulfamethoxazole it was lower than 80%. Resistances were more frequent (p < 0.001) in males and in the elderly. DISCUSSION: Escherichia coli was the most frequent strain, revealing less resistance to fosfomycin and nitrofurantoin. Antimicrobial susceptibility was lower in the elderly and in males, populations in whom empirical therapy may be less successful. CONCLUSION: In order to improve clinical results, we recommend periodic surveillance of antimicrobial susceptibility, which could enable the provision of efficient information to clinicians, namely those who prescribe empirically for such infections, as well as standardization of identification methods of bacterial strains diagnosis and of the antibiotic kits to be tested.

Introdução: As infeções do trato urinário são muito frequentes na comunidade. É essencial conhecer o padrão de sensibilidade aos antibióticos para uma terapêutica empírica racional. O objetivo deste estudo é determinar a prevalência e o perfil de suscetibilidade aos antibióticos dos microrganismos implicados em infeções urinárias a nível dos cuidados primários de saúde, no distrito de Coimbra.Material e Métodos: Neste estudo observacional e transversal, analisámos 7134 uroculturas positivas de laboratórios de ambulatório do distrito de Coimbra, no período de um ano. Na maioria dos casos, a urocultura positiva foi definida por um limiar de 105 unidadesformadoras de colónias por mililitro e executada através do sistema automatizado VITEK® 2, da bioMérieux. Usámos estatística descritiva e inferencial para determinar a prevalência e a sensibilidade aos antibióticos dos microrganismos e averiguar a relação destas com o sexo e com a idade.Resultados: Do total de uroculturas positivas, 83,4% pertencia ao sexo feminino e 41,0% pertencia à população acima dos 75 anos. A Escherichia coli foi o microrganismo mais frequente (63,9%), mas a sua prevalência foi inferior (p < 0,001) no sexo masculino e acima dos 75 anos. A sua sensibilidade à fosfomicina e à nitrofurantoína foi superior a 95% e à ciprofloxacina e ao cotrimoxazol foi inferior a 80%. As resistências foram mais frequentes (p < 0,001) no sexo masculino e nos mais idosos.Discussão: A Escherichia coli foi o microrganismo mais frequente, verificando-se menores percentagens de resistência desta à fosfomicina e à nitrofurantoína. A sensibilidade aos antibióticos foi menor em idades mais avançadas e também no sexo masculino (p < 0,001), populações onde a antibioterapia empírica pode ter maior risco de insucesso.Conclusão: Recomendamos a monitorização periódica do perfil de sensibilidade aos antibióticos, para eficaz informação aos médicos que têm de proceder a terapêutica empírica deste tipo de infeções, bem como a uniformização das técnicas de identificação das estirpes bacterianas e dos conjuntos de antibióticos a serem testados nos antibiogramas.

Aislamientos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria / Isolation of Acinetobacter spp. in infections associated with health care

Introducción: El Acinetobacter spp. se ha convertido en un germen de gran relevancia clínica, resulta un verdadero paradigma de las infecciones nosocomiales multirresistentes. Objetivo: Caracterizar los aislamientos microbiológicos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria. Métodos: Estudio descriptivo que incluyó 280 aislamientos de Acinetobacter spp. de las muestras provenientes de pacientes hospitalizados, en el periodo de tres años (del 2016 al 2018) en el Hospital Comandante "Manuel Fajardo Rivero". Las variables del estudio fueron: salas de procedencia del aislamiento, tipo de muestra, factor predictivo, diagnóstico infectológico, susceptibilidad antimicrobiana in vitro y multidrogorresistencia, Resultados: El mayor número de aislamientos de Acinetobacter spp. se obtuvo en la unidad de cuidados intensivos (78,9 por ciento), las secreciones respiratorias fueron las muestras con más aislamientos (58,9 por ciento), la ventilación mecánica resultó el factor predictivo más frecuente (67,9 por ciento) y como diagnóstico infectológico, la neumonía asociada al ventilador (66,8 por ciento). Se encontró un porcentaje elevado de cepas con multidrogorresistencia (73,6 por ciento). Conclusiones: El Acinetobacter spp. se encuentra vinculado a las infecciones asociadas a los servicios de salud, fundamentalmente en los cuidados intensivos. Los antimicrobianos probados evidenciaron altos porcentajes de resistencia, con predominio de las cepas multidrogorresistentes(AU)

Introduction: Acinetobacter spp. has become a germ of great clinical relevance, it is a true paradigm of multiresistant nosocomial infections. Objective: To characterize the microbiological isolates of Acinetobacter spp. in infections associated with health care. Methods: Descriptive study that included 280 isolates of Acinetobacter spp. from the samples of hospitalized patients, in the period of three years (from 2016 to 2018) in the Hospital Comandante "Manuel Fajardo Rivero". The variables of the study were: wards of origin of the isolation, type of sample, predictive factor, infectious diagnosis, antimicrobial susceptibility in vitro and multidrug resistance. Results: The highest number of isolates of Acinetobacter spp. was obtained in the intensive care unit (78.9 percent), the respiratory secretions were the samples with the most isolations (58.9 percent), mechanical ventilation was the most frequent predictor (67.9 percent) and as an infectious diagnosis, ventilator-associated pneumonia (66.8 percent). A high percentage of strains with multidrug resistance (73.6 percent) was found. Conclusions: Acinetobacter spp. is linked to infections associated with health services, mainly in intensive care. The antimicrobials tested showed high percentages of resistance, with a predominance of multidrug resistant strains(AU)