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1.
Artigo em Inglês | MEDLINE | ID: mdl-31522665

RESUMO

From 1 January to 31 December 2017, 36 institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2017 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,515 S. aureus bacteraemia episodes were reported, of which 77% were community-onset. Approximately one in five S. aureus (19.0%) were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 18.7% which was significantly higher than the 14.0% mortality associated with methicillin-susceptible SAB. With the exception of the ß-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the ß-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin and ciprofloxacin and approximately 14% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in five S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). ST22-IV [2B] (EMRSA-15) is the predominant healthcare-associated clone in Australia. Seventy-five percent of methicillin-resistant SAB were due to community-associated clones. Although polyclonal approximately 74% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5] and ST1-IV [2B]. CA-MRSA, in particular the ST45-VT [5C2&5] clone has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. ST45-VT [5C2&5] accounted for 12.8% of CA-MRSA. As CA-MRSA is well established in the Australian community it is important antimicrobial resistance patterns in community- and healthcare-associated SAB is monitored as this information will guide therapeutic practices in treating S. aureus sepsis.


Assuntos
Anti-Infecciosos/farmacologia , Bacteriemia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Epidemiologia Molecular , Infecções Estafilocócicas/microbiologia , Adulto Jovem
2.
Medicine (Baltimore) ; 98(35): e16903, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464922

RESUMO

Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62-16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks-1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.


Assuntos
Endocardite Bacteriana/epidemiologia , Próteses Valvulares Cardíacas/microbiologia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Estafilocócicas/epidemiologia , Idoso , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Gerenciamento Clínico , Endocardite Bacteriana/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Estafilocócicas/etiologia , Análise de Sobrevida , Tempo para o Tratamento
3.
Pan Afr Med J ; 32: 166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303935

RESUMO

Introduction: Superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria. Methods: A descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for Acinetobacter spp and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method. Results: One hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (NIs) were caused by Gram-negative bacteria, predominantly Escherichia coli, Klebseilla spp, Proteus spp, Pseudomona spp and Acinetobacter spp. In-vitro antibiotic susceptibility test revealed that acinetobacter were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem. Conclusion: Superbugs (Acinetobacter species) significantly contributed to delayed hospital admissions through observed 100% resistance to used antibiotics. The healthcare managers of these hospitals and the ministry of health need to take measures against this resistant bacteria (Acinetobacter spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.


Assuntos
Antibacterianos/farmacologia , Infecções Bacterianas/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Estudos Transversais , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana Múltipla , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 582, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277589

RESUMO

BACKGROUND: Varicella zoster virus (VZV) is a highly contagious herpesvirus with potential for nosocomial transmission. However, the importance of nosocomial chickenpox outbreak in China has often been ignored. With the increasing immunocompromised population in China, a thorough review of issues related to nosocomial transmission and the seroprevalence rate of VZV among healthcare workers is necessary. METHODS: Retrospective case finding for nosocomial transmission of chickenpox was conducted between January 1, 2013 and December 31, 2017. Cases were identified based on clinical features compatible with chickenpox. A cross-sectional study on the seroprevalence rate of VZV among healthcare workers (HCWs) was conducted between January 1, 2014 and December 31, 2017. The serum VZV antibodies of 1804 HCWs were measured by enzyme-linked immunosorbent assay (ELISA). The seroprevalence rate of VZV antibodies, the positive predictive value and negative predictive value of self-reported history of varicella were analyzed. The economic impact associated with nosocomial transmission of VZV was also assessed. RESULTS: A total of 8 cases of chickenpox were identified in three nosocomial transmissions, including 4 HCWs who were infected nosocomially. The overall seroprevalence rate of VZV was 88.4%, which significantly increased with age (P < 0.01). The seroprevalence rates of HCWs with different genders and occupations showed no statistically significant differences. The positive and negative predictive values of a self-reported history of varicella were 80.8 and 10.6% respectively. An estimation of 163.3 person-days of work were lost in each nosocomial transmission and 86.7 infection control unit person-hours were required for each outbreak investigation. The cost of VZV IgG ELISA screening was estimated to be 83 USD per nosocomial transmission. CONCLUSIONS: Nosocomial transmission of VZV occurred repeatedly in the hospital setting. An alarming 11.6% of HCWs were seronegative for VZV, which might increase the risk of nosocomial infection and outbreak for other susceptible co-workers and patients. This is especially important in the setting of a teaching hospital where many immunocompromised patients were managed. Furthermore, the positive predictive value of self-reported varicella on seroprevalence rate in our study was lower than those reported in other countries, therefore serological testing of VZV antibodies with subsequent vaccination for all non-immune HCWs should be considered.


Assuntos
Varicela/transmissão , Pessoal de Saúde/estatística & dados numéricos , Infecção pelo Vírus da Varicela-Zoster/transmissão , Adolescente , Adulto , Anticorpos Antivirais/sangue , Varicela/epidemiologia , China/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Estudos Transversais , Surtos de Doenças , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Herpesvirus Humano 3/imunologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Soroepidemiológicos , Estudantes de Medicina/estatística & dados numéricos , Infecção pelo Vírus da Varicela-Zoster/epidemiologia
5.
BMC Infect Dis ; 19(1): 551, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226946

RESUMO

BACKGROUND: At the end of March 2018, a clustered outbreak of measles associated with health care workers occurred in northern Taiwan. Prior to this study, the policy for measles vaccination for physicians and nurses in MacKay Memorial Hospital, Taiwan was encouragement of vaccination in medical personnel working in the emergency room or other high risk divisions without prior testing for measles antibody, and vaccination coverage was only 85.3%. It was important to urgently formulate a new strategy to achieve zero tolerance for intra-hospital transmission and epidemic prevention. This study aimed to explore the effectiveness of a new strategy for the prevention of an outbreak of measles. METHODS: This study was conducted from April 23, 2018 to May 22, 2018 in the MacKay Memorial Hospital, a medical center and tertiary teaching hospital with 2200 beds in northern Taiwan. First-line medical personnel in the hospital underwent a free screening for measles antibody as a new strategy for measles outbreak prevention. Susceptible medical personnel were advised to receive measles vaccination. RESULTS: A total of 719 first-line medical personnel were enrolled for the general survey. Measles seropositivity was 76.1% (287/377) in the generation born after 1978 (vaccinated), and 96.5% (330/342) in the generation born before 1978 (p < 0.001), while the overall seropositivity was 85.8% (617/719). Vaccination coverage of susceptible personnel under the new strategy reached 86.3% in the first month (88/102) following the survey. At the end of the first month after implementation of the new strategy, 98.1% of the medical personnel were seropositive or revaccinated, and reached 99.4% at the end of the second month. CONCLUSIONS: In this study, rapid, free antibody screening during a measles outbreak and subsequent vaccination of those susceptible resulted in most of the first-line medical personnel being seropositive or revaccinated. The new strategy was effective, time saving, used little manpower, and of low cost. Screening for measles antibody free of charge followed by vaccination of seronegative medical personnel can be regarded as an effective health management strategy to reduce and prevent the spread of measles infection.


Assuntos
Surtos de Doenças/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Política de Saúde , Controle de Infecções , Vacina contra Sarampo/uso terapêutico , Sarampo/prevenção & controle , Cobertura Vacinal , Adulto , Idoso , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Pessoal de Saúde/normas , Hospitais de Ensino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Masculino , Sarampo/epidemiologia , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Taiwan/epidemiologia , Centros de Atenção Terciária , Vacinação/estatística & dados numéricos , Cobertura Vacinal/métodos , Cobertura Vacinal/organização & administração , Cobertura Vacinal/normas , Adulto Jovem
6.
BMC Infect Dis ; 19(1): 357, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035966

RESUMO

BACKGROUND: Overcrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany. METHODS: During a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV). RESULTS: During OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed. CONCLUSIONS: Prevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff's diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.


Assuntos
Infecção Hospitalar/diagnóstico , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/metabolismo , Enterobacter cloacae/genética , Enterobacter cloacae/isolamento & purificação , Feminino , Alemanha/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Hospitais Universitários , Humanos , Incidência , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino
7.
Isr Med Assoc J ; 5(21): 303-307, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140219

RESUMO

BACKGROUND: With the widespread use of antifungal agents, the frequency of non-albicans Candida (NAC) blood-stream infections (BSI) is increasing. OBJECTIVES: To describe the epidemiology, clinical manifestations, and risk factors for NAC BSI, focusing on prior antifungal and immunosuppressive therapy. METHODS: The authors conducted an observational, retrospective cohort study among adult patients with candidemia at the Rambam Health Care Campus, a tertiary medical center in Israel, between 2009 and 2015. Comparisons between patients with Candidemia albicans and NAC candidemia were performed. Regression analysis, with NAC BSI as the dependent variable and significant risk factors for NAC as independent variables, was performed. RESULTS: A total of 308 episodes of candidemia were included. C. albicans was isolated in 30.8% of patients (95/308), while NAC spp. were isolated in the rest. Significant independent risk factors for NAC included immunosuppression therapy (odds ratio [OR] 0.38, 95% confidence interval [95%CI] 0.19-0.76) and previous azole use (OR 0.2, 95%CI 0.06-0.710). The interaction between prior azole and immunosuppression therapy in the model was not significant, and after its inclusion in the model only immunosuppression remained significantly associated with NAC. In the subgroup of patients who did not receive prior azoles, immunosuppression therapy, neutropenia, and bone marrow transplantation were significantly associated with NAC. CONCLUSIONS: Independent of previous azole treatment, immunosuppressive therapy was a significant risk factor for NAC in our cohort.


Assuntos
Antifúngicos , Candida albicans , Candida , Candidemia , Candidíase , Infecção Hospitalar , Idoso , Antifúngicos/classificação , Antifúngicos/uso terapêutico , Candida/classificação , Candida/isolamento & purificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
8.
BMC Infect Dis ; 19(1): 416, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088521

RESUMO

BACKGROUND: Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effect of CHG bathing on prevention of HABSIs and assessed fidelity to implementation of this behavioral intervention. METHODS: We undertook a meta-analysis by searching Medline, EMBASE, CINAHL, Scopus, and Cochrane's CENTRAL registry from database inception through January 4, 2019 without language restrictions. We included randomized controlled trials, cluster randomized trials and quasi-experimental studies that evaluated the effect of CHG bathing versus a non-CHG comparator for prevention of HABSIs in any adult healthcare setting. Studies of pediatric patients, of pre-surgical CHG use, or without a non-CHG comparison arm were excluded. Outcomes of this study were HABSIs, patient-centered outcomes, such as patient comfort during the bath, and implementation fidelity assessed through five elements: adherence, exposure or dose, quality of the delivery, participant responsiveness, and program differentiation. Three authors independently extracted data and assessed study quality; a random-effects model was used. RESULTS: We included 26 studies with 861,546 patient-days and 5259 HABSIs. CHG bathing markedly reduced the risk of HABSIs (IRR = 0.59, 95% confidence interval [CI]: 0.52-0.68). The effect of CHG bathing was consistent within subgroups: randomized (0.67, 95% CI: 0.53-0.85) vs. non-randomized studies (0.54, 95% CI: 0.44-0.65), bundled (0.66, 95% CI: 0.62-0.70) vs. non-bundled interventions (0.51, 95% CI: 0.39-0.68), CHG impregnated wipes (0.63, 95% CI: 0.55-0.73) vs. CHG solution (0.41, 95% CI: 0.26-0.64), and intensive care unit (ICU) (0.58, 95% CI: 0.49-0.68) vs. non-ICU settings (0.56, 95% CI: 0.38-0.83). Only three studies reported all five measures of fidelity, and ten studies did not report any patient-centered outcomes. CONCLUSIONS: Patient bathing with CHG significantly reduced the incidence of HABSIs in both ICU and non-ICU settings. Many studies did not report fidelity to the intervention or patient-centered outcomes. For sustainability and replicability essential for effective implementation, fidelity assessment that goes beyond whether a patient received an intervention or not should be standard practice particularly for complex behavioral interventions such as CHG bathing. TRIAL REGISTRATION: Study registration with PROSPERO CRD42015032523 .


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Infecção Hospitalar/diagnóstico , Clorexidina/administração & dosagem , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Incidência , Unidades de Terapia Intensiva
9.
Wiad Lek ; 72(4): 513-518, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055523

RESUMO

OBJECTIVE: Introduction: Intra-abdominal infections are a common cause of morbidity and mortality worldwide. Early clinical diagnosis and appropriate antimicrobial therapy are the cornerstones in the management of all infections. The aim: Aim of our work was to obtain the first national estimates of the current prevalence of intra-abdominal infections and resistance of their causative agents to antibiotics in Ukrainian hospitals. PATIENTS AND METHODS: Materials and methods: In total of 1986 patients with microbiologically proven IAI were included in the study. The identification and antimicrobial susceptibility to antibiotics of cultures were determined, using automated microbiology analyzer and Kirby - Bauer antibiotic testing. RESULTS: Results: Among 1986 patients, 1404 (70.7%) community-acquired and 582 (29.3%) nosocomial infections were observed. Death during hospitalization was reported in 4.1% community-acquired cases and 7.7% nosocomial cases. The distribution of the microorganisms differed according to the nosocomial or community origin of the infection but not according to their location. In nosocomial patients were observed with increased proportions of Enterococcus faecalis and Pseudomonas aeruginosa. The carbapenems and amikacin were the most consistently active against Enterobacteriaceae. Against P. aeruginosa, amikacin, imipenem, ceftazidime and ciprofloxacin were the most active agents in community-acquired infections, while imipenem, cefepime and amikacin were the most active agents in nosocomial cases. CONCLUSION: Conclusions: The significant risk factors defined should be addressed preoperatively to decrease the risk for nosocomial infections. Antibiotics application tactics should be determined in accordance with the local data of resistance to them in each surgical hospital.


Assuntos
Infecções Intra-Abdominais/epidemiologia , Antibacterianos/farmacologia , Infecção Hospitalar/epidemiologia , Enterobacteriaceae , Mortalidade Hospitalar , Humanos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa , Ucrânia/epidemiologia
10.
BMC Public Health ; 19(1): 426, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014305

RESUMO

BACKGROUND: The frequency of antimicrobial resistance has steadily increased worldwide, induced by inappropriate use of antibiotics in a variety of settings. We analyzed the ecological correlation between fluoroquinolone consumption and levofloxacin resistance in Escherichia coli in Japan. METHODS: We collected information on cases of E. coli resistant to levofloxacin in 2015-2016 in all 47 prefectures from the Japan Nosocomial Infections Surveillance system. Information on fluoroquinolone consumption was obtained from pharmaceutical sales data. To address potential confounding, we also collected information on the number of physicians, nurses, and medical facilities per 100,000 individuals. RESULTS: We identified higher fluoroquinolone consumption and higher resistance in western prefectures, and lower consumption and resistance in eastern prefectures. Multivariate analysis identified a positive correlation between fluoroquinolone consumption and levofloxacin resistance in both 2015 and 2016. CONCLUSIONS: Fluoroquinolone consumption and levofloxacin-resistant E. coli are potentially associated on a nationwide scale. The relationship between the two must be elucidated using additional studies with different epidemiological designs, so that any possible counter-measures, including alternative prescription, can be considered in the future.


Assuntos
Antibacterianos/provisão & distribução , Farmacorresistência Bacteriana , Infecções por Escherichia coli/epidemiologia , Escherichia coli/efeitos dos fármacos , Fluoroquinolonas/provisão & distribução , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Bases de Dados de Produtos Farmacêuticos/estatística & dados numéricos , Infecções por Escherichia coli/tratamento farmacológico , Geografia , Humanos , Japão/epidemiologia , Levofloxacino/farmacologia , Testes de Sensibilidade Microbiana
11.
Int J Infect Dis ; 83: 88-94, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930184

RESUMO

BACKGROUND: Lassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt. METHODS: We analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel. RESULTS: The index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission. CONCLUSION: Maintaining a high index of suspicion for Lassa fever in all patients, especially in endemic areas, is essential in adhering to adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is a need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient's provisional diagnosis.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Instalações de Saúde , Pessoal de Saúde , Febre Lassa/epidemiologia , Doenças Profissionais/epidemiologia , Adolescente , Adulto , Infecção Hospitalar/etiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Controle de Infecções , Febre Lassa/diagnóstico , Febre Lassa/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças Profissionais/etiologia , Inquéritos e Questionários
12.
Braz J Infect Dis ; 23(2): 143-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30935817

RESUMO

BACKGROUND: There is little information on herpes zoster from hospital registries in South America. The aim of this study was to describe the epidemiological and clinical aspects of herpes zoster (HZ) in hospitalized patients.' METHODS: We searched for hospital-based records during the period from March 2000 to January 2017 in a 700-bed tertiary-care hospital located in southern Brazil. The medical records of all eligible patients were reviewed, and data regarding demographics, medical history, clinical and laboratory characteristics, treatment regimens, and clinical outcomes were collected. Patients were also evaluated for mortality. RESULTS: There were 801 records of herpes zoster according to the proposed criteria. Most patients with HZ presented a cutaneous clinical form of the disease with involvement of a single dermatome (n=589, 73.5%). Additional clinical characteristics included postherpetic neuralgia (22.1%), ophthalmic HZ (7.6%) and meningoencephalitis (2.7%). Most patients presented immunocompromised conditions (64.9%) including HIV, administration of immunosuppressive agents, and malignant neoplasms. During this period, there were 105 (13.1%) deaths, which were mostly unrelated to HZ. Five deaths were related to HZ meningoencephalitis. CONCLUSION: The results of this study demonstrate a high burden of HZ disease in a Brazilian tertiary care hospital in the HZ vaccination era. Awareness of the incidence and comorbidity factors associated with HZ in Latin American countries such as Brazil contribute for adoption and implementation of strategies for immunization in this area.


Assuntos
Infecção Hospitalar/epidemiologia , Herpes Zoster/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
13.
Biomed Res Int ; 2019: 7634528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949509

RESUMO

Healthcare associated infection (HAI) is known to increase the economic burden of patients while the medical cost due to MDRO HAI is even higher. Three hundred eighty-one multidrug resistance organisms (MDROs) healthcare associated infection (HAI) case-patients and three hundred eighty-one matched control-patients were identified between January and December in 2015. The average total hospitalization medical cost of the case group was $6127.65 and that of the control group was $2274.02. The difference between the case group and the control group was statistically significant (t = 21.07; P < 0.01). The attributable cost of MDRO HAI was $3853.63. The direct medical costs due to different MDRO infections were different. The increased medical costs of CR-AB, CR-KP, and CR-PA were significantly higher than that of MRSA, MRSE, ESBL E. coli, and ESBL Kp (P < 0. 05). Among the subitem expenses, the drug cost increased the most (the average cost was $1457.72), followed by the treatment fee and test fee; the differences were statistically significant (P < 0.01).


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas , Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Hospitalização , Hospitais , Idoso , Bactérias/classificação , Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , China/epidemiologia , Custos e Análise de Custo , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/terapia , Feminino , Humanos , Masculino
14.
Adv Clin Exp Med ; 28(7): 907-912, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30986000

RESUMO

BACKGROUND: Infections in critically ill patients are the main reasons for a lack of therapeutic success and increased mortality in intensive care units (ICUs). There have been many analyses of the incidence of infections in ICUs; however, no large studies of this kind have been conducted either in Poland or in Eastern and Central Europe. OBJECTIVES: The aim of the research was to undertake a one-day study of the prevalence of infections in ICUs in Warszawa and the Mazovian region of Poland. MATERIAL AND METHODS: A prospective questionnaire survey analysis - a one-day prevalence study of infections - was carried out on June 25, 2014, in 28 ICUs in Poland. RESULTS: Among 205 ICU patients (193 adults and 12 children), 134 infections were found in 101 patients (99/193 adults (51.30%) and 2/12 children (16.70%)), and bacterial colonization in 19/205 (9.3%) patients. In 66.42% of the cases, more than 1 site of infection was diagnosed. On the day of the study, 75.40% of the diagnosed infections had positive microbiological results. The most frequent were respiratory tract infections (53.73%), wound infections (18.65%) and bloodstream infections (14.92%). Most of the infections (64.10%) were caused by Gram-negative bacteria (GN), followed by Gram-positive bacteria (GP; 31.80%) and fungi (4.10%). The most frequently reported GN microorganisms were Enterobacteriaceae (44.7%). Methicillin-resistant Staphylococcus aureus (MRSA) infections were found in 8.80% of the patients. Antibiotics were administered to 75.60% of the adult patients, in 69.20% as targeted treatment. Mechanical ventilation, central vein catheterization and urinary bladder catheterization were used in 67.80%, 85.85% and 94.63% of the patients, respectively. CONCLUSIONS: On the day of the study, more than half of the patients had infections, mostly from GN bacteria. Respiratory tract infections were the main type found. In about 2/3 of the patients, antibiotics were administered, mainly as targeted therapy.


Assuntos
Infecção Hospitalar/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Urinárias/epidemiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Cuidados Críticos , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Micoses , Polônia/epidemiologia , Prevalência , Estudos Prospectivos , Infecções Respiratórias/microbiologia , Inquéritos e Questionários , Infecções Urinárias/microbiologia , Adulto Jovem
15.
BMC Pulm Med ; 19(1): 79, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991976

RESUMO

BACKGROUND: In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. METHODS: A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April-October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. RESULTS: Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9-5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p < 0.001). Hospital-acquired influenza cases occurred in two distinct clusters. Patients were moved an average of 5 times after diagnosis. Mean length of stay following diagnosis was 13 days compared to 5 days for community-acquired cases (p < 0.001). Of the patients with hospital-acquired influenza, 22 were in shared rooms during their incubation period and 9 were not isolated in single rooms following diagnosis. Treatment was initiated within the recommended 48 h period following symptom onset for 62.5% of hospital-acquired cases compared with 39.8% of community-acquired cases (p = 0.033). CONCLUSIONS: Our results show that clinical presentation differed between patients with hospital-acquired influenza compared with those who acquired influenza in the community. Cases occurred in two clusters suggesting intra-hospital transmission rather than random importation from the community, highlighting the importance of infection control measures to limit influenza spread. Patients with hospital-acquired influenza may present without classical features of an influenza-like illness and this should promote earlier diagnostic testing and isolation to limit spread. Movement of patients after diagnosis is likely to facilitate spread within the hospital.


Assuntos
Infecção Hospitalar/epidemiologia , Influenza Humana/epidemiologia , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Comorbidade , Infecção Hospitalar/virologia , Feminino , Hospitalização , Humanos , Controle de Infecções/métodos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estações do Ano , Vigilância de Evento Sentinela
17.
Transplant Proc ; 51(2): 392-395, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879550

RESUMO

INTRODUCTION: Preservation solutions (PS), in which grafts for patients undergoing liver transplantation are stored, represent a medium suitable for microorganism growth and a potential source for transmission of pathogenic germs to the transplant recipients. The aim of the present study was to review the relevant literature for the incidence and predictors of positive microbiological findings in the PS. PATIENTS AND METHODS: We performed a literature review of publications on bacterial and fungal contamination of PS during cold organ storage focusing on its impact on bacteremia and/or nosocomial infection of the recipient. RESULTS: Overall 19 studies were reviewed, published between the years 2000 and 2016, that encompassed a total of 5647 patients. Positive cultures were identified in 1428 patients (25%). The documentation of bacteremia showed a wide deviation with documented ranges between 0% and 69%. Data on the identification of same species or of related nosocomial infections were only sparsely available; same species were found in a rate of 0% to 8%, and nosocomial infections were attributed to them in an incidence of 0% to 19%. CONCLUSIONS: Our study underlines both the limited published data and the contradictory available information on contamination of preservation solution in solid organ transplantation, not allowing for any recommendations. The necessity for prospective, multicentric studies on this topic is mandatory.


Assuntos
Infecção Hospitalar/etiologia , Contaminação de Medicamentos/estatística & dados numéricos , Soluções para Preservação de Órgãos/efeitos adversos , Transplante de Órgãos/efeitos adversos , Adulto , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos/efeitos adversos , Preservação de Órgãos/métodos , Estudos Prospectivos , Transplantados
18.
Transplant Proc ; 51(2): 408-412, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30879553

RESUMO

PURPOSE: We investigated the association of ureteral stenting after kidney transplantation with the development of urinary tract infections (UTIs) and/or urinary tract colonization, in a hospital environment considered endemic for multidrug resistant (MDR) Gram-negative Enterobacteriaceae. METHODS: Seventy-five recipients of deceased donor grafts were divided in groups A and B. Group A (with subgroups A1 and A2) included 45 transplanted patients without urinary stenting, and group B 30 patients with stenting. Subgroup A1 consisted of 30 patients transplanted before 2006, and A2 of 15 patients transplanted after 2006, when MDR, mainly carbapenem-resistant, Enterobacteriaceae, frequency has risen in our hospital. RESULTS: The incidence and the number of UTIs per patient were significantly higher in patients without stenting compared to those with stenting. (Group A: 32/45 vs group B: 9/30, P < .001, and group A: 2.86 ± 0.43 vs group B: 0.6 ± 0.19, P < .01 respectively). Patients without stenting tended to have a higher frequency of recurrent UTIs compared to those with stenting (group A: 16/45 vs group B: 4/30, P < .05). Asymptomatic bacteriuria was more frequent in the patients with stent (group A: 8/45 vs group B: 14/30, P < .05). Further sub-comparison of the A1 and A2 subgroups with group B did not change the statistical results. CONCLUSIONS: There is no clinically significant association of ureteral stenting after kidney transplantation with the high frequency of MDR Gram-negative bacteria in our hospital.


Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Transplante de Rim/métodos , Infecções Urinárias/epidemiologia , Adulto , Idoso , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Stents , Ureter/cirurgia
19.
MBio ; 10(2)2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30914511

RESUMO

The population structure of health care-associated pathogens reflects patterns of diversification, selection, and dispersal over time. Empirical data detailing the long-term population dynamics of nosocomial pathogens provide information about how pathogens adapt in the face of exposure to diverse antimicrobial agents and other host and environmental pressures and can inform infection control priorities. Extensive sequencing of clinical isolates from one hospital spanning a decade and a second hospital in the Cleveland, OH, metropolitan area over a 3-year time period provided high-resolution genomic analysis of the Acinetobacter baumannii metapopulation. Genomic analysis demonstrated an almost complete replacement of the predominant strain groups with a new, genetically distinct strain group during the study period. The new group, termed clade F, differs from other global clone 2 (GC2) strains of A. baumannii in several ways, including its antibiotic resistance and lipooligosaccharide biosynthesis genes. Clade F strains are part of a large phylogenetic group with broad geographic representation. Phylogenetic analysis of single-nucleotide variants in core genome regions showed that although the Cleveland strains are phylogenetically distinct from those isolated from other locations, extensive intermixing of strains from the two hospital systems was apparent, suggesting either substantial exchange of strains or a shared, but geographically restricted, external pool from which infectious isolates were drawn. These findings document the rapid evolution of A. baumannii strains in two hospitals, with replacement of the predominant clade by a new clade with altered lipooligosaccharide loci and resistance gene repertoires.IMPORTANCE Multidrug-resistant (MDR) A. baumannii is a difficult-to-treat health care-associated pathogen. Knowing the resistance genes present in isolates causing infection aids in empirical treatment selection. Furthermore, knowledge of the genetic background can assist in tracking patterns of transmission to limit the spread of infections in hospitals. The appearance of a new genetic background in A. baumannii strains with a different set of resistance genes and cell surface structures suggests that strong selective pressures exist, even in highly MDR pathogens. Because the new strains have levels of antimicrobial resistance similar to those of the strains that were displaced, we hypothesize that other features, including host colonization and infection, may confer additional selective advantages and contribute to their increased prevalence.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/classificação , Acinetobacter baumannii/isolamento & purificação , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Lipopolissacarídeos/metabolismo , Microbiota , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/transmissão , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/patogenicidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Variação Genética , Genótipo , Hospitais , Epidemiologia Molecular , Ohio/epidemiologia , Filogenia , Fatores de Virulência/metabolismo
20.
APMIS ; 127(4): 181-186, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30908773

RESUMO

The objective of this study was to investigate a sudden increase in methicillin-resistant Staphylococcus aureus (MRSA) cases primarily in one maternity ward at the Center for Children's and Women's Health at Linköping University Hospital, Sweden. Approximately 300 individuals including patients, their family members, and healthcare workers were screened for MRSA. The antibiotic susceptibility was tested and isolates polymerase chain reaction (PCR)-positive for the mecA gene were spa typed. Isolates with the same antibiogram and spa type were further whole genome sequenced. Compliance to current cleaning and hygiene routines was also controlled, and environmental samples collected. The results showed that a total of 13 individuals were involved in the outbreak. It was caused by a t386 MRSA strain (ST-1, NCBI-accession AB505628) with additional resistance to erythromycin and clindamycin. All cases were epidemiologically connected to the index patient, who had recently emigrated from a high-endemic area for MRSA. With improved cleaning and better compliance to basic hygiene routines, no further cases were reported. This study demonstrates how rapid an MRSA strain can disseminate in a ward with susceptible patients and insufficient cleaning and hygiene. For a better control of MRSA, clinical cultures and screening samples need to be obtained early and more extensively than according to the current recommendations.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Proteínas de Bactérias/genética , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa , Farmacorresistência Bacteriana Múltipla , Estudos Epidemiológicos , Feminino , Maternidades , Humanos , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem Molecular , Proteínas de Ligação às Penicilinas/genética , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/transmissão , Suécia/epidemiologia , Sequenciamento Completo do Genoma
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