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1.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 81-89, abr. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188155

RESUMO

Objetivo: Diseñar un modelo sencillo de riesgo para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el servicio de urgencias hospitalario (SUH). Métodos: Estudio observacional, de cohortes retrospectivo, de todos los hemocultivos (SUH) extraídos en un SU en los pacientes adultos ($18 años) atendidos por infección desde el 1 de julio de 2018 hasta el 31 de marzo de 2019. Se analizaron 38 variables independientes (demográficas, comorbilidad, funcionales, clínicas y analíticas) que pudieran predecir la existencia de bacteriemia. Se realizó un estudio univariado y multivariable, mediante regresión logística, y después se construyó una escala de puntuación de riesgo. Resultados: Se incluyeron 2.181 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 262 (12%) y como HC negativos 1.919 (88%). Entre los negativos, 1.755 (80,5%) no tuvieron crecimiento y 164 (7,5%) se consideraron contaminados. Se definió un modelo predictivo de bacteriemia con 5 variables (5MPB-Toledo). El modelo incluyó la temperatura > 38,3°C (1 punto), un índice de Charlson $ 3 (1 punto), la frecuencia respiratoria $ 22 respiraciones por minuto (1 punto), leucocitos > 12.000/mm3 (1 punto) y procalcitonina $ 0,51 ng/ml (4 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,1%, 10,5% y 77%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,946 (IC 95%: 0,922-0,969). Conclusiones: El Modelo 5MPB-Toledo podría ser de utilidad para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el SUH


Objectives: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. Methods: Retrospective observational short study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. Results: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). Conclusion: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/diagnóstico , Infecções/epidemiologia , Serviços Médicos de Emergência , Estudos de Coortes , Prognóstico , Medição de Risco/métodos , Valor Preditivo dos Testes , Bacteriemia/epidemiologia , Estudos Retrospectivos , Hemocultura/métodos , Modelos Logísticos , Bactérias/isolamento & purificação , Análise Estatística
2.
J Med Microbiol ; 69(4): 552-557, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32141812

RESUMO

Introduction. Staphylococcus aureus bacteraemia (SAB) causes significant morbidity and mortality. Standard diagnostic methods require 24-48 h to provide results, during which time management is guideline-based and may be suboptimal.Aim. Evaluate the impact of rapid molecular detection of S. aureus in positive blood culture bottle fluid on patient management.Methodology. Samples were tested prospectively at two clinical centres. Positive blood cultures with Gram-positive cocci in clusters on microscopy were tested with the Xpert MRSA/SA blood culture assay (Cepheid), as well as standard culture-based identification and antimicrobial sensitivity tests. Results were passed to clinical microbiologists in real time and used for patient management.Results. Of 264 blood cultures tested (184 and 80 from each centre), S. aureus was grown from 39 (14.8 %) with one identified as methicillin-resistant S. aureus; all Xpert results agreed with culture results. Median turnaround time from culture flagging positive to result reporting for Xpert was 1.7 h, compared to 25.7 h for species identification by culture. Xpert results allowed early changes to management in 40 (16.8 %) patients, with Xpert positive patients starting specific therapy for SAB and Xpert negative patients stopping or avoiding empiric antimicrobials for SAB.Conclusion. Rapid and accurate detection of S. aureus with the Xpert MRSA/SA BC assay in positive blood culture bottles allowed earlier targeted patient management. Negative Xpert results are suggestive of coagulase negative staphylococci, allowing de-escalation of antimicrobial therapy if clinically appropriate.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Bacteriemia/sangue , Bacteriemia/microbiologia , Sangue/microbiologia , Humanos , Estudos Prospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética
3.
BMC Infect Dis ; 20(1): 142, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059701

RESUMO

BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.


Assuntos
Bacteriemia/microbiologia , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Hemocultura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bactérias Aeróbias/patogenicidade , Bactérias Anaeróbias/patogenicidade , Hemocultura/métodos , Queimaduras/complicações , Queimaduras/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/microbiologia , Estudos Retrospectivos , Centros de Atenção Terciária
4.
PLoS One ; 15(2): e0228935, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101540

RESUMO

The objective of this study was to assess whether use of matrix assisted laser desorption ionization-time of flight (MALDI-TOF), through improvements in identification time, reduces time to directed antibiotic coverage. We therefore conducted a retrospective review of 377 blood cultures from hospitalized patients with gram negative bacteremia that underwent testing by MALDI-TOF compared to standard identification methods (VITEK 2) for blood cultures from January 2016 to December 2017. We found that MALDI significantly reduced time between blood culture collection to reach pathogen identification and was associated with a significantly reduced time to initiate more specific therapy, with a mean difference of 16.37 hours, 95% CI 10.05 to 22.69 (mean time 50.34 hours (+/- 21.21) vs VITEK: 66.71 hrs (+/- 27.12), p<0.001 as well as a reduced time to discontinue previous therapy (p = 0.004). In conclusion, in reducing time to identification of gram negative bacteremia, MALDI-TOF led to improvements in antibiotic coverage.


Assuntos
Bacteriemia/diagnóstico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Humanos , Estudos Retrospectivos
5.
Int J Infect Dis ; 91: 124-128, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786245

RESUMO

BACKGROUND: Studies have shown improvement in the outcome of blood stream infections (BSI) due to the use of Rapid PCR-Based Blood Culture Identification Panel (BCID) in Antimicrobial stewardship programs (ASP). There is currently no data on the use of BCID with ASP in the United Arab Emirates (UAE). METHOD: Pre-post quasiexperimental study included hospitalized patients with BSI, their positive blood cultures on BCID were studied in 2 groups: conventional culture with ASP (AS), and BCID with ASP (BCID). The primary outcomes were time to first appropriate antimicrobial therapy, infection related length of stay (LOS), ICU admission, 14 days bacteremia recurrence and in-hospital mortality. Secondary outcomes were 30 days reinfection rate, hospital cost and ASP interventions. RESULTS: Out of total 477 positive blood cultures, 206 (AS and BCID) with real BSI were included. The time needed for organism identification was shorter in the BCID group than in the AS group (1.3 h vs. 51 h; P = 0.0002). BCID had a shorter time to appropriate antimicrobial therapy than AS (17.8 h vs.45 h; P = 0.0004). No statistical difference was observed in mortality rate, 14 days bacteremia recurrence, ICU admission, hospital cost, LOS or ASP interventions. CONCLUSION: Implementing BCID to ASP significantly decreased the time needed to identify the organism and time to appropriate antimicrobial therapy. Similarly, LOS and hospital cost were reduced, however, the reduction was not statistically significant.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Reação em Cadeia da Polimerase/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Árabes , Bacteriemia/sangue , Bacteriemia/microbiologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Emirados Árabes Unidos
6.
Arch Pathol Lab Med ; 144(2): 215-220, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31295014

RESUMO

CONTEXT.­: Blood culture contamination is a common problem faced by medical centers and leads to significant cost. A possible method to reduce contamination is to discard the initial aliquot of blood, which contains skin and bacteria. OBJECTIVE.­: To determine whether the rate of contaminant blood cultures could be reduced by changing the order of draw to divert the first 7 mL to a gold- or green-top tube. DESIGN.­: A preintervention and postintervention study was conducted. During the 18-month intervention phase (September 2015-February 2017), all nurses in the emergency department and inpatient floor phlebotomists collected blood cultures by drawing the first 7 mL of blood into a gold- or green-top tube followed by drawing blood for blood culture bottles. The 18 months immediately preceding the study period (February 2014-July 2015) were used for comparison. RESULTS.­: There was an overall statistically significant decrease in contamination rate from 2.46% in the prediversion protocol group to 1.70% in the postdiversion protocol group (P < .001). Emergency department drawn cultures and inpatient cultures showed significant decrease in contamination rates between the preprotocol and postprotocol groups, 2.92% versus 1.95% (P < .001) for emergency department, and 1.82% versus 1.31% (P = .03) for inpatient. We noted less month-to-month variation during the study period compared with the preintervention period. CONCLUSIONS.­: By using this simple diversion method, we were able to improve blood culture contamination rates for our emergency department and inpatients while incurring no added cost to the procedure.


Assuntos
Hemocultura/métodos , Coleta de Amostras Sanguíneas/métodos , Flebotomia/métodos , Hospitais Comunitários , Humanos
7.
PLoS One ; 14(12): e0225999, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826003

RESUMO

INTRODUCTION: To determine whether on-site incubation of blood cultures at the intensive care unit (ICU) improves not only the time to incubation but also time to positivity, time to knowledge of positivity and time to results (identification and antibiotic susceptibility testing). METHODS: This observational single-centre study in ICU patients with severe sepsis and septic shock investigated the impact of blood culture incubation immediately on-site at the ICU (ICU group) by comparison with traditional processing in a remote laboratory (LAB group) on different time intervals of blood culture diagnostics from obtaining blood to clinician notification of final result. The effect of on-site incubation was evaluated in Kaplan-Meier estimates for the time to positivity, time to knowledge of positivity and time to microbiological results and a linear mixed model was built. RESULTS: A total of 3,549 blood culture sets from 657 ICU patients were analysed: 2,381 in the LAB group and 1,168 in the ICU group. Overall, 660 (18.6%) blood culture sets were positive and 2,889 (81.4%) sets remained negative. On-site incubation was associated with reduced time to knowledge of positivity (46.9 h [CI 43.4-50.8 h] vs. 28.0 h [CI 23.6-32.2 h], p < 0.001) and reduced time to result (61.4 h [CI 58.4-64.8 h] vs. 42.1 h [CI 39.1-47.5 h], p < 0.001). In blood cultures processed instantaneously at the ICU compared to incubation in the remote laboratory within 4 h, the time to microbiological result was significantly reduced by 8.5 h (p < 0.001). Pre-existing anti-infective therapy had no significant impact on diagnostic time intervals. CONCLUSIONS: Instantaneous incubation of blood cultures in the ICU compared to incubation in a remote laboratory significantly improves time to knowledge to positivity and time to result. These effects are even more pronounced during off-hours of the microbiological laboratory. The results underline the importance of 24/7 diagnostics to provide round-the-clock processing of blood culture samples in patients with sepsis and septic shock and an immediate to communication of the results to the clinicians.


Assuntos
Hemocultura/métodos , Sepse/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/patologia , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Choque Séptico/patologia , Fatores de Tempo
8.
Ann Biol Clin (Paris) ; 77(6): 665-667, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31859643

RESUMO

Continuous monitoring of the performances of blood culture instrument can be based on the indicators proposed by the QUAMIC. Of these, the analytic performance indicator evaluates the rate of false-positive vials. False-positives vials can be reported by the device in case of leukocytosis or when vials are overfilled. In our laboratory, we record prospectively in our software all false positive vials as well as the position used for their incubation. These data are analyzed at least twice a year. For the first half of 2016, this strategy allowed us to identify a defective position. We then evaluated the impact of this anomaly as very weak. The one-year follow-up after the position repair confirmed a correction of the problem. Thus, traceability of positions reporting unexplained false-positive vials (i.e. neither due to leukocytosis nor overfilled vials) can allow laboratories to identify a defective position. This survey, if done prospectively, is simple to perform and not time-consuming. It could usefully complement the analytical performance indicator based on the false-positive rate.


Assuntos
Hemocultura/instrumentação , Análise de Falha de Equipamento , Leucocitose/diagnóstico , Artefatos , Hemocultura/métodos , Hemocultura/normas , Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Meios de Cultura/farmacologia , Reações Falso-Positivas , Seguimentos , Violeta Genciana , Humanos , Contagem de Leucócitos/instrumentação , Contagem de Leucócitos/normas , Leucocitose/sangue , Fenazinas , Reprodutibilidade dos Testes
9.
Biomed Res Int ; 2019: 8041746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687399

RESUMO

We evaluated a rapid bacterial identification (rID) and a rapid antimicrobial susceptibility testing by disk diffusion (rAST) from positive blood culture to overcome the limitations of the conventional methods and reduce the turnaround time in bloodstream infection diagnostics. The study included hemocultures flagged as positive by bacT/ALERT®, identification by MALDI-TOF MS, and rAST. The results were compared to identification and antimicrobial susceptibility testing (AST) results by current standard methods, after 24 h incubation. For rAST categorical agreement (CA), very major errors (VME), major errors (ME), and minor errors (mE) were calculated. A total of 524 bacterial samples isolated from blood cultures were obtained, including 246 Gram-negative (GN) and 278 Gram-positive (GP) aerobes. The overall concordance of rID was 88.6%, and it was highest among GN (96%). A total of 2196 and 1476 antimicrobial agent comparisons were obtained for GN and GP, respectively. Evaluation of rAST, CA, VME, ME, and mE disclosed 97.7, 0.7, 0.5, and 1.1% for GN and 98.0, 0.5, 0.7, and 0.8% for GP, respectively. Meropenem CA, VME, and ME were 98.3, 0.5, and 0.5%, respectively; mE was not observed. Oxacillin CA, ME, and mE were 97.4, 1.6, and 0.6%, respectively; VME was not observed. Overall, kappa scores of the results of the comparisons demonstrated the high agreement between rAST and the standard method. Identification and AST of aerobic bacteria from positive blood cultures after a short period of incubation on solid blood agar is a fast and reliable method that may improve the management of bloodstream infections.


Assuntos
Bacteriemia/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Técnicas de Tipagem Bacteriana/métodos , Hemocultura/métodos , Meios de Cultura/metabolismo , Testes Diagnósticos de Rotina/métodos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana/métodos , Oxacilina/farmacologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Fatores de Tempo
11.
ABCS health sci ; 44(2): 96-102, 11 out 2019. tab, ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1022342

RESUMO

INTRODUÇÃO: A automação laboratorial é cada vez mais utilizada em microbiologia, no entanto, poucos estudos avaliam desfechos clínicos em comparação aos métodos tradicionais. No Brasil, nenhum estudo com esse objetivo foi detectado. OBJETIVO: Analisar os impactos clínicos e microbiológicos após implantação de método fenotípico automatizado em um serviço de microbiologia. MÉTODOS: Realizamos estudo observacional e retrospectivo no laboratório de microbiologia referente a exame de hemocultura de pacientes da Unidade de Terapia Intensiva (UTI). Os dados foram coletados de pacientes internados entre janeiro/2014 a dezembro/2015. Analisou-se o tempo de internação, número de terapias empíricas, óbitos e dados relacionados ao isolamento microbiológico. A amostra foi obtida por conveniência. Para a comparação entre os desfechos foram empregados os testes t de Student e Qui-quadrado de Pearson. O programa empregado foi o Stata release, versão 11, sendo considerados significativos valores de p<0,05. RESULTADOS: Foram avaliados 472 pacientes. Não houve redução na prescrição empírica de antimicrobianos (54,7% vs 45,3%; p=0,33), tempo de internação na UTI (14,5 dias vs 15,8 dias p=0,78) e na taxa de óbitos (54,4% vs 45,6%; p=0,36). Similarmente, o perfil de agentes isolados em ambos os métodos não parece ser discrepante, no entanto, houve um aumento de 44,7% no número de isolados microbianos (76 vs 110) com melhor caracterização dos mesmos. CONCLUSÃO: A automação do laboratório de microbiologia não impactou no tempo de internação, mortalidade na UTI e no número de terapias empíricas. No entanto, a identificação e o isolamento de microrganismos melhoraram.


INTRODUCTION: Automation is increasingly used in microbiology laboratory, however, few studies assessed clinical outcomes compared to traditional methods. In Brazil, no studies with this objective were detected. OBJECTIVE: To analyze the clinical and microbiological impacts after implantation of an automated phenotypic method in a microbiology service. METHODS: Observational and retrospective study carried out on the microbiology laboratory involving blood culture test from intensive care unit (ICU) patients. Data were collected from hospitalized patients between January 2014 and December 2015. The length of hospitalization, number of empirical therapies, deaths and information related to microbiological isolation were analyzed. The sample was obtained by convenience. Pearson's Chisquare and Student's t-tests were used to compare outcomes. The program used was the Stata release, version 11, being considered significant values of p<0.05. RESULTS: A total of 472 patients were evaluated. There was no reduction in the empirical prescription of antimicrobials (54.7% vs 45.3%; p=0.33), ICU stay (14.5 days vs 15.8 days; p=0.78) and mortality (54.4% vs 45.6%; p=0.36). Similarly, profile of isolated agents in both methods did not appear to be discrepant, however, there was an increase of 44.7% in the number of microbial isolates (76 vs 110) and a better characterization of them. CONCLUSION: The microbiology laboratory automation did not modify the length of stay, ICU mortality and the number of empirical therapies. However, identification and isolation of microorganisms was improved.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Testes de Sensibilidade Microbiana/instrumentação , Testes de Sensibilidade Microbiana/métodos , Automação Laboratorial/instrumentação , Automação Laboratorial/métodos , Hemocultura/instrumentação , Hemocultura/métodos , Microbiologia/instrumentação
12.
Mo Med ; 116(4): 313-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527981

RESUMO

The use of blood cultures as a diagnostic tool has increased over the years along with improvements in techniques and results. The diagnostic dilemma arises when blood cultures are positive and there is possibility of contamination. Hence obtaining blood cultures in the appropriate setting and the interpretation of blood cultures by the hospitalist is imperative to the management of the hospitalized patient.


Assuntos
Hemocultura , Infecção Hospitalar/diagnóstico , Sepse/diagnóstico , Hemocultura/métodos , Coleta de Amostras Sanguíneas/métodos , Infecção Hospitalar/sangue , Humanos , Pacientes Internados , Sepse/sangue
13.
Metas enferm ; 22(7): 15-22, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184097

RESUMO

Objetivo: conocer la variabilidad de la técnica de extracción de hemocultivos en la práctica clínica de los enfermeros, así como valorar las diferencias en función de la existencia o no de un protocolo. Método: estudio descriptivo transversal realizado en 2018 mediante encuesta online de participación voluntaria y anónima, difundida a través del Consejo General de Enfermería, 200 direcciones-gerencia de centros hospitalarios nacionales, perfiles privados, institucionales y páginas de grupos. Se diseñó un cuestionario ad hoc de 23 preguntas para explorar variables sociodemográficas, laborales y relacionadas con la extracción de hemocultivos: existencia de protocolo en el servicio, indicaciones de solicitud correctas y cuestiones técnicas. Se realizó un análisis descriptivo de la muestra, así como un análisis bivariante mediante la prueba x2 de Pearson. Resultados: participaron 1.516 profesionales (84,4% mujeres, 64,4% con experiencia mayor a 10 años). El 53,2% refirió la existencia de un protocolo específico en su servicio. Quienes disponían de protocolo empleaban con mayor frecuencia el equipo estéril, clorhexidina alcohólica al 2% para la desinfección de la piel y algún tipo de antiséptico para la desinfección de los tapones (p< 0,001); en caso de muestras del catéter venoso central, fue más habitual que extrajeran otra muestra de un acceso periférico (p< 0,001), cambiaran la aguja para inocular la sangre en los frascos (p< 0,05) sin desechar ninguna cantidad (p< 0,001) y recogieran unos 10 cc de frente a otros volúmenes (p< 0,01). Conclusiones: hay una alta variabilidad en la realización de la técnica y diferencias en función de la existencia o no de un protocolo. La unificación de procedimientos consensuados se torna necesaria para optimizar y rentabilizar la extracción de hemocultivos


Objective: to understand the variability in the technique for blood culture extraction in the clinical practice of nurses, as well as to assess any differences based on whether there is a protocol or not. Method: a descriptive cross-sectional study conducted in 2018 through an on-line survey with voluntary and anonymous participation; it was distributed through the General Council of Nurses, 200 managements of national hospitals, private and institutional profiles, and group webpages. A 23-question ad-hoc questionnaire was designed, in order to explore sociodemographical, and occupational variables, as well as those associated with blood culture extraction: the existence of a protocol in the unit, correct indications of application, and technical matters. A descriptive analysis of the sample was conducted, as well as bivariate analysis through Pearson's x2 test. Results: the study included 1,516 professionals (84.4% were women, 64.4 % with >10-year experience); 53.2% of them reported there was a specific protocol in their unit. Those who had a protocol used more frequently the sterile equipment, chlorhexidine 2% for skin disinfection, and some type of antiseptic for disinfecting the stoppers (p< 0.001). In the case of central venous catheter samples, it was more frequent that they extracted another sample from a peripheral (p< 0.001), changed the needle in order to inject the blood into the vials (p< 0.05) without discarding any (p< 0.001), and collected 10cc vs. other volumes (p< 0.01). Conclusions: there is high variability in terms of conducting the technique, as well as differences based on whether there is a protocol or not. The standardization of procedures by consensus becomes necessary in order to optimize and make the most of blood culture extraction


Assuntos
Humanos , Feminino , Adulto , Hemocultura/instrumentação , Competência Clínica , Enfermeiras Clínicas/organização & administração , Hemocultura/métodos , Hemocultura/estatística & dados numéricos , Estudos Transversais , Inquéritos e Questionários
14.
Neth J Med ; 77(6): 227-230, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391330

RESUMO

A 65-year-old male was admitted to the Intensive Care Unit after being resuscitated because of a hypoxic cardiac arrest caused by influenza. Blood cultures taken at time of admission surprisingly grew Bacillus mycoides, a spore-producing apathogenic agriculture bacterium. We collected culture samples at his barge. Although we did not culture Bacillus mycoides, we did find multiple other Bacillus species. We hypothesised that our patient was colonised from the freights of his barge, and bloodstream infection occurred during resuscitation with either the bacterium itself or its spores. To our knowledge, this is the first report on bloodstream infection with Bacillus mycoides in a human patient.


Assuntos
Doenças dos Trabalhadores Agrícolas , Bacillus/isolamento & purificação , Ressuscitação/efeitos adversos , Sepse , Vancomicina/administração & dosagem , Idoso , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças dos Trabalhadores Agrícolas/microbiologia , Antibacterianos/administração & dosagem , Hemocultura/métodos , Parada Cardíaca/terapia , Humanos , Masculino , Países Baixos , Ressuscitação/métodos , Sepse/diagnóstico , Sepse/etiologia , Sepse/microbiologia , Resultado do Tratamento
15.
Rev. esp. quimioter ; 32(4): 365-369, ago. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-188829

RESUMO

OBJECTIVE: Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) is widely used for fast identification of bacteria from blood cultures (BC). We compared the performance of two procedures, one including a pre-enrichment step in brain heart infusion and the other a direct method using vacutainer separator gel tubes (DI), for identification of bacteria from blood cultures by MALDI-TOF MS. MATERIAL AND METHODS: We first prepared a training set of 20 simulated bacteremia specimens, including 10 Gram-negative and 10 Gram-positive species. A total of 145 non-consecutive BCs flagged as positive (68 Gram-negative rods, and 77 Gram-positive cocci) were prospectively analyzed (validation set). RESULTS: A total of 82% and 49% of isolates were correctly identified to the species level by the respective methods. CONCLUSION: The pre-enrichment method outperformed the DI method for identification of virtually all bacterial species included in the panels


OBJETIVO: La espectrometría de masas MALDI-TOF se utiliza comúnmente para la identificación rápida de bacterias crecidas en hemocultivos (HC). Hemos comparado el rendimiento de dos procedimientos, uno que incluye un paso previo del enriquecimiento en caldo corazón-cerebro y el otro un método directo que usa tubos vacutainer con gel separador (DI), para la identificación de bacterias a partir de hemocultivos mediante MALDI-TOF MS. MATERIAL Y MÉTODOS: Analizamos prospectivamente un total de 145 HC no consecutivos (68 con crecimiento de bacterias gramnegativas y 77 de cocos grampositivos). RESULTADOS: Un total de 82% y 49% de los aislamientos fueron identificados correctamente a nivel de especie por los dos métodos, respectivamente. CONCLUSIÓN: El rendimiento del método de pre-enriquecimiento en caldo corazón-cerebro fue mejor que el del método DI para la identificación de la práctica totalidad de las especies bacterianas incluidas en el panel de estudio


Assuntos
Humanos , Bacteriemia/microbiologia , Hemocultura/métodos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Técnicas de Tipagem Bacteriana/métodos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Estudos Prospectivos
16.
Rev Esp Quimioter ; 32(4): 365-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31293114

RESUMO

OBJECTIVE: Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) is widely used for fast identification of bacteria from blood cultures (BC). We compared the performance of two procedures, one including a pre-enrichment step in brain heart infusion and the other a direct method using vacutainer separator gel tubes (DI), for identification of bacteria from blood cultures by MALDI-TOF MS. METHODS: We first prepared a training set of 20 simulated bacteremia specimens, including 10 Gram-negative and 10 Gram-positive species. A total of 145 non-consecutive BCs flagged as positive (68 Gram-negative rods, and 77 Gram-positive cocci) were prospectively analyzed (validation set). RESULTS: A total of 82% and 49% of isolates were correctly identified to the species level by the respective methods. CONCLUSIONS: The pre-enrichment method outperformed the DI method for identification of virtually all bacterial species included in the panels.


Assuntos
Bacteriemia/microbiologia , Hemocultura/métodos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Técnicas de Tipagem Bacteriana/métodos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Humanos , Estudos Prospectivos
17.
Am J Health Syst Pharm ; 76(7): 460-469, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31361820

RESUMO

PURPOSE: Antimicrobial stewardship programs (ASPs) can be aided by using rapid diagnostics (RDT). However, there are limited data evaluating the impact of ASPs and RDT on sepsis outcomes in the setting of the new Sepsis-3 guidelines. This study evaluates the impact of a low-resource method for ASPs with RDT on sepsis outcomes. METHODS: This was a prospective, quasi-experimental study with a retrospective double pretest. Patients ≥ 18 years old with sepsis and concurrent bacteremia or fungemia were included; patients who were pregnant, had polymicrobial septicemia or who were transferred from an outside hospital were excluded. In the first pretest (O1), polymerase chain reaction was used to identify Staphylococcal species from positive blood cultures, and traditional laboratory techniques were used to identify other species. Matrix-assisted laser desorption ionization time-of-flight mass spectroscopy and FilmArray were implemented in the second pretest (O2), and twice daily blood culture review was implemented in the posttest (O3). RESULTS: A total of 394 patients (157 in O1, 176 in O2, 61 in O3) were enrolled. Clinical response was 73.2%, 83.5%, and 88.5% in O1, O2, and O3, respectively, p = 0.013. By Cox regression, the O3 was associated with improved time to clinical response (hazard ratio, 1.388; 95% confidence interval, 1.004-1.919) as compared with O1. Mortality, hospital length of stay, and intensive care unit length of stay were unchanged between groups. CONCLUSION: Twice-daily blood culture review may be useful for implementing rapid diagnostics within low-resource ASPs. Further research is needed to identify the optimal method of blood culture follow-up within low-resource settings.


Assuntos
Gestão de Antimicrobianos/métodos , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Procedimentos Clínicos , Fungemia/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/normas , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Hemocultura/economia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Fatores de Tempo
18.
BMC Infect Dis ; 19(1): 607, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291897

RESUMO

BACKGROUND: Blood culture bottles (BCBs) provide a semiautomated method for culturing periprosthetic tissue specimens. A study evaluating BCBs for culturing clinical samples other than body fluids is needed before implementation into clinical practice. Our objective was to evaluate use of the BacT/Alert® Virtuo blood culture system for culturing periprosthetic tissue specimens. METHODS: The study was performed through the analysis of spiked (n = 36) and clinical (n = 158) periprosthetic tissue samples. Clinical samples were analyzed by the BCB method and the results were compared to the conventional microbiological culture-based method for time to detection and microorganisms identified. RESULTS: The BacT/Alert® Virtuo blood culture system detected relevant bacteria for prosthetic joint infection in both spiked and clinical samples. The BCB method was found to be as sensitive (79%) as the conventional method (76%) (p = 0.844) during the analyses of clinical samples. The BCB method yielded positive results much faster than the conventional method: 89% against 27% detection within 24 h, respectively. The median detection time was 11.1 h for the BCB method (12 h and 11 h for the aerobic and the anaerobic BCBs, correspondingly). CONCLUSION: We recommend using the BacT/Alert® Virtuo blood culture system for analyzing prosthetic joint tissue, since this detect efficiently and more rapidly a wider range of bacteria than the conventional microbiological method.


Assuntos
Bactérias/isolamento & purificação , Hemocultura/métodos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Hemocultura/instrumentação , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/patologia , Sensibilidade e Especificidade , Manejo de Espécimes , Fatores de Tempo
20.
BMC Res Notes ; 12(1): 316, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31167646

RESUMO

OBJECTIVE: We set an experiment to determine the diagnostic performance of the Widal test and stool culture in typhoid-suspected cases attending tertiary hospitals in Dar es Salaam, Tanzania using blood culture as a golden standard. We also evaluated the agreement between Widal, stool and blood culture. RESULTS: This was a cross-sectional study conducted between June and September 2018, in three Regional Referral Hospitals in Dar es Salaam, Tanzania. A total of 158 typhoid-suspected cases were enrolled, after obtaining an informed consent. Of the 158 patients participated in the study, 128 (81%) tested positive for the Widal test and 17 (11%) patients were stool culture positive. Widal test recorded 81.5% sensitivity, 18.3% specificity, 10.1% positive predictive value and 89.7% negative predictive value. Stool culture showed 31.3% sensitivity, 91.5% specificity, 29% positive predictive value and 91.5% negative predictive value. In conclusion, Widal test is not reliable for diagnosis of typhoid fever since false positive and negative results are common. In addition, Widal test recorded poor agreement with the blood culture (kappa = 0.014, p < 0.05) while stool culture had strong agreement with the blood culture (kappa = 0.22, p < 0.05).


Assuntos
Técnicas de Cultura de Células , Testes Diagnósticos de Rotina/estatística & dados numéricos , Salmonella typhi/isolamento & purificação , Febre Tifoide/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes de Aglutinação/estatística & dados numéricos , Hemocultura/métodos , Criança , Pré-Escolar , Estudos Transversais , Reações Falso-Negativas , Reações Falso-Positivas , Fezes/microbiologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella typhi/imunologia , Sensibilidade e Especificidade , Tanzânia , Febre Tifoide/imunologia , Febre Tifoide/microbiologia
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