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1.
Ann R Coll Surg Engl ; 102(7): e176-e179, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32803988

RESUMO

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe Clostridium difficile colitis in a post-treatment and recovered COVID-19 patient. A 64-year-woman with a one-month hospital admission for severe bilateral pneumonia associated with COVID-19 and 10 days after discharge presented with diarrhoea and abdominal pain. Severe C. difficile-associated colitis is diagnosed according to clinical features and CT findings. An urgent pancolectomy was performed due to her bad response to conservative treatment. Later evolution slowly improved to recovery. C. difficile-associated colitis is one of the most common hospital-acquired infections. Significant patient-related risk factors for C. difficile infection are antibiotic exposure, older age, and hospitalisation. Initial therapeutic recommendations in our country included administration broad-spectrum antibiotics to all patients with bilateral pneumonia associated with SARS-CoV-2. These antibiotics are strongly associated with C. difficile infection. Our patient developed a serious complication of C. difficile due to the use of broad-spectrum antibiotics. The appearance of late digestive symptoms in patients diagnosed and treated for COVID-19 should alert clinicians to the possibility of C. difficile infection. The updated criteria for severe colitis and severe C. difficile infection should be considered to ensure an early effective treatment for the complication.


Assuntos
Antibacterianos/uso terapêutico , Betacoronavirus , Clostridium difficile/isolamento & purificação , Colite/etiologia , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Pneumonia Viral/complicações , Colite/tratamento farmacológico , Colite/microbiologia , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
2.
Antimicrob Resist Infect Control ; 9(1): 110, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678049

RESUMO

BACKGROUND: Healthcare-associated infections (HAIs) are a global public health problem. For the fulfillment of Saudi Arabia's Vision 2030, the promotion of preventive care medicine through HAI management is a crucial issue. This study explores the perspectives of Saudi tertiary healthcare workers (HCWs) on HAIs and infection control measures. METHODS: Quantitative data were assessed to determine HCWs' knowledge of HAI and their attitudes towards and practice of infection control measures. Semi-structured interviews were used to collect qualitative data from 40 doctors and nurses. The interviews were audio-recorded and transcribed verbatim. Further, routine sterile procedures in the wards and intensive care units were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was videographed and transcribed. Both interview data and reflective discussion of the video were analysed using thematic analysis. The quantitative data were analysed using the Kruskal-Wallis test and logistic regression analysis. RESULTS: Kruskal-Wallis test revealed no difference in mean knowledge, attitude, or practice scores between nurses/ doctors or the genders. There was a significant difference in knowledge score and practice scores between the Intensive care unit & the Paediatric ward /infection control department with the maximum scores in knowledge and practice among participants from the intensive care unit. Logistic regression analysis for dependent variables (knowledge and attitude) and independent variables like age, gender, designation, and departments was not significant. The qualitative data yielded four themes: knowledge of HAI and infection control, infection control measures in practice, a shortfall in infection control measures and HAI, and required implementation. Video-reflexive ethnography (VRE) revealed lapses in handwashing practice and proper usage of personal protective equipment (PPE), especially surgical masks. CONCLUSION: Early introduction of training programmes in medical and nursing schools and video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to HCWs. A possible reason for the outbreak of Middle East Respiratory Syndrome coronavirus in this part of Saudi Arabia could be a lapse in PPE usage. Intensive training programs for all the HCWs, strict vigilant protocols, and a willingness to change behaviour and practice, will significantly benefit the spread of outbreaks.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/métodos , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Adulto , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Feminino , Desinfecção das Mãos , Humanos , Masculino , Coronavírus da Síndrome Respiratória do Oriente Médio , Equipamento de Proteção Individual , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
PLoS One ; 15(6): e0234376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569265

RESUMO

BACKGROUND: Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. AIMS AND OBJECTIVE: The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. METHODS: A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). RESULTS: Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. CONCLUSION: The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.


Assuntos
Infecção Hospitalar/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Infecções Relacionadas a Cateter/etiologia , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/terapia , Feminino , Hemoglobinas/metabolismo , Humanos , Falência Renal Crônica/sangue , Masculino , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
5.
Artigo em Alemão | MEDLINE | ID: mdl-32590859

RESUMO

The processes of anaesthesia during operations enable surgical disciplines to perform a wide range of procedures. However, anaesthesia procedure may also represent a potential risk of infection for the surgical patient. Important hygiene measures concern the following topics: hand hygiene, surface disinfection, administration of parenteral drugs, dealing with catheters, intubation, perioperative antibiotic prophylaxis, temperature management, change intervals, OR workflow organization. The selection of hygiene measures for anaesthesia staff in the operating theatre listed in this article is presented in the sequence of the work flow, whereby certain topics such as hand hygiene naturally play an important role in all work phases.


Assuntos
Anestesia , Infecção Hospitalar , Higiene das Mãos , Infecção da Ferida Cirúrgica , Anestesia/efeitos adversos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Desinfecção , Humanos , Higiene
10.
Surg Infect (Larchmt) ; 21(4): 301-308, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-88662

RESUMO

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Aerossóis/efeitos adversos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Instalações de Saúde/normas , Humanos , Controle de Infecções/métodos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/normas , Intubação Intratraqueal/efeitos adversos , Segurança do Paciente/normas , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
11.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: covidwho-42091

RESUMO

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Assuntos
Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Doenças do Sistema Digestório , Endoscopia do Sistema Digestório/normas , Gastroenterologia/normas , Controle de Infecções/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/virologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/microbiologia , Doenças do Sistema Digestório/virologia , Unidades Hospitalares/normas , Humanos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Pneumonia Viral/virologia
12.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32267098

RESUMO

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Assuntos
Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Doenças do Sistema Digestório , Endoscopia do Sistema Digestório/normas , Gastroenterologia/normas , Controle de Infecções/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/virologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/microbiologia , Doenças do Sistema Digestório/virologia , Unidades Hospitalares/normas , Humanos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Pneumonia Viral/virologia
13.
PLoS One ; 15(4): e0232175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348343

RESUMO

Trauma patients are at risk of repeated hospital-acquired infections, however predictive scores aiming to identify susceptibility to such infections are lacking. The objective of this study was to investigate whether commonly employed disease-severity scores can successfully predict susceptibility to multiple independent infectious episodes (MIIEs) among trauma patients. A secondary analysis of data derived from the prospective, longitudinal study "Inflammation and the Host Response to Injury" ("Glue Grant") was performed. 1,665 trauma patients, older than 16, were included. Patients who died within seven days from the time of injury were excluded. Five commonly used disease-severity scores [Denver, Marshall, Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury Severity Score (ISS), and New Injury Severity Score (NISS)] were examined as independent predictors of susceptibility to MIIEs. The latter was defined as two or more independent infectious episodes during the index hospital stay. Multivariable logistic regression was used for the statistical analysis. 22.58% of the population was found to be susceptible to MIIEs. Denver and Marshall scores were highly predictive of the MIIE status. For every 1-unit increase in the Denver or the Marshall score, there was a respective 15% (Odds Ratio:1.15; 95% CI: 1.07-1.24; p < 0.001) or 16% (Odds Ratio:1.16; 95% CI: 1.09-1.24; p < 0.001) increase in the odds of MIIE occurrence. APACHE II, ISS, and NISS were not independent predictors of susceptibility to MIIEs. In conclusion, the Denver and Marshall scores can reliably predict which trauma patients are prone to MIIEs, prior to any clinical sign of infection. Early identification of these individuals would potentially allow the implementation of rapid, personalized, preventative measures, thus improving patient outcomes and reducing healthcare costs.


Assuntos
Infecção Hospitalar/etiologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/complicações , APACHE , Adulto , Infecção Hospitalar/epidemiologia , Suscetibilidade a Doenças , Feminino , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
14.
Surg Infect (Larchmt) ; 21(4): 301-308, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32310715

RESUMO

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos/normas , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Adulto , Aerossóis/efeitos adversos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Instalações de Saúde/normas , Humanos , Controle de Infecções/métodos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/normas , Intubação Intratraqueal/efeitos adversos , Segurança do Paciente/normas , Assistência Perioperatória/métodos , Pneumonia Viral/complicações
15.
Artigo em Inglês | MEDLINE | ID: mdl-32019085

RESUMO

Most of the healthcare facilities (HFs) have to face the nosocomial infections (NIs), which increase the rates of morbidity, mortality, and financial burden on the HFs and the patients. The control of the NIs is a global issue and requires additional effort. Because the pathogenic microbes can be transmitted among all the HF departments, the layout and design of the HFs (or the department configuration) is considered to play a significant role in control of the NIs. A few of the departments transmit the microbes more than other departments, called 'cause', while some other departments are more infected than others, called 'effect'. Here, the researchers have stated that both the cause and effect departments are risky. This research tried to propose a comprehensive mathematical algorithm for choosing the high-risk department(s) by applying the NI and the managerial criteria to minimize NIs through rearchitecting of the HFs. To develop the algorithm, the researchers applied the multiple criteria decision-making (MCDM) methods. They used Decision-Making Trial and Evaluation Laboratory (DEMATEL) and modified weighted sum method (WSM) methods, and their hybrid, along with a modified nominal group technique (NGT) for data collection. The proposed algorithm was later validated by implementation in a HF as a case study. Based on all results of the algorithm, the high-risk departments in the HF were identified and proposed to be eliminated from the HF in such a way that the facility would retain its functionality. The algorithm was seen to be valid, and the feasibility of the algorithm was approved by the top managers of the HF after the algorithm was implemented in the case study. In conclusion, the proposed algorithm was seen to be an effective solution for minimizing the NIs risk in every HF by eliminating the high-risk departments, which could simplify the HF manager's decisions.


Assuntos
Algoritmos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Tomada de Decisões , Instalações de Saúde , Gestão de Riscos , Arquitetura , Serviços de Saúde , Humanos , Projetos de Pesquisa
16.
Artigo em Inglês | MEDLINE | ID: mdl-31991722

RESUMO

Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017-2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioides difficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioides difficile, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacter baumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioides difficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI.


Assuntos
Infecção Hospitalar/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecção Hospitalar/classificação , Infecção Hospitalar/etiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Romênia/epidemiologia , Adulto Jovem
17.
BMC Infect Dis ; 20(1): 64, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964345

RESUMO

BACKGROUND: The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). METHODS: We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children's Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0-1 months old), infants (1-12 months old) and children (1-10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. RESULTS: A total of 11,651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9, 15.4, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769-0.829; P < 0.001), STS risk grade (OR 1.267, 95%CI: 1.159-1.385; P < 0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023-1.639; P = 0.032), BMI >95th percentile (OR 0.792, 95%CI: 0.647-0.969; P = 0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003-1.012; P < 0.001) and aortic clamping time (OR 1.009, 1.002-1.015; P = 0.008) were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167-1.633; P < 0.001), BMI < 5th percentile (OR 1.934, 95%CI: 1.377-2.715; P < 0.001), CPB time (OR 1.018, 95%CI: 1.015-1.022; P < 0.001), lymphocyte/WBC ratiocut off value (OR 1.546, 95%CI: 1.119-2.136; P = 0.008) were significantly associated with nosocomial infection in CHD children. CONCLUSION: Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecção Hospitalar/etiologia , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/microbiologia , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
18.
Br J Nurs ; 29(1): 8, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917933

RESUMO

Tracy Doherty, Assistant Director of Infection Prevention & Control, Our Lady of Lourdes Hospital, Drogheda, Co Louth, discusses the maintenance of a clean healthcare environment.


Assuntos
Infecção Hospitalar/etiologia , Ambiente de Instituições de Saúde , Infecção Hospitalar/prevenção & controle , Ambiente de Instituições de Saúde/normas , Serviço Hospitalar de Limpeza/normas , Humanos , Controle de Infecções
19.
Postgrad Med ; 132(2): 167-171, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31766930

RESUMO

Objectives: To understand the role of ophthalmoscopic examination (dilated retina examination and widefield fundus photography) in the diagnosis and management of nosocomial acquisition of Mycobacterium chimaera following open heart surgery with cardiopulmonary bypass utilizing a heater-cooler unit, an entity that is associated with >50% mortality during the worldwide outbreak that has occurred since 2013.Methods: Case report with review of previous cases.Results: Signature Mycobacterium chimaera chorioretinal lesions can be used as a diagnostic sign and a biomarker for assessment of treatment efficacy.Conclusions: Ophthalmologic examination can play a key role in diagnosis and management of systemic Mycobacterium chimaera following cardiopulmonary bypass; such examinations may yield earlier diagnosis, diminishing mortality rates.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Coriorretinite/diagnóstico , Infecção Hospitalar/diagnóstico , Infecções por Mycobacterium/diagnóstico , Mycobacterium , Idoso , Biomarcadores , Coriorretinite/etiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Humanos , Masculino , Infecções por Mycobacterium/etiologia , Oftalmoscopia
20.
Transplant Proc ; 52(1): 289-294, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31837819

RESUMO

BACKGROUND: A Klebsiella pneumoniae infection is a life-threatening disease among abdominal solid organ transplant (ASOT) recipients. The objectives of our present work are to investigate the distribution and drug resistance of pathogens, and clinical manifestation among ASOT recipients suffering from K pneumoniae infections. METHODS: The medical records of 53 ASOT recipients with 63 episodes of K pneumoniae infections from October 1, 2013 to June 1, 2019 were reviewed according to the Declaration of Helsinki and the Declaration of Istanbul. There were no grafts from prisoners used in these 53 patients and the donors were not coerced or paid. The distribution and drug resistance of each pathogen and clinical manifestation among ASOT recipients with K pneumoniae infections were retrospectively reviewed and summarized. RESULTS: Prevalence and mortality of K pneumoniae infections among ASOT recipients were 4.5% and 32.1%, respectively. The origins of K pneumoniae infections were the blood (n = 21), deep wound and skin (n = 10), urinary tract (n = 9), abdomen (n = 6), and lung (n = 7). The numbers of organs from donors after cardiac death and living-related donors were 52 and 1, respectively. Twenty-nine patients had a serum creatinine level >1.5 mg/dL at the onset of K pneumoniae infections. Fifty-eight percent of K pneumoniae strains were carbapenem resistant. The resistance rate of K pneumoniae to 5 of 12 antibiotics investigated was more than 60%. The strains were relatively susceptible to meropenem, tigecycline, sulfamethoxazole, and amikacin; while there were distinctly increasing trends of resistance to meropenem and amikacin as time went on. CONCLUSIONS: The clinical manifestation of K pneumoniae infections included elevated serum creatinine level, high carbapenem-resistant rate, and mortality. The drug-resistance rates of K pneumoniae to the most commonly used antibiotics were high with an increasing trend of resistance in recent years. Tigecycline, meropenem, sulfamethoxazole, and amikacin are recommended to treat K pneumoniae infections among ASOT recipients.


Assuntos
Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Infecções por Klebsiella , Complicações Pós-Operatórias/microbiologia , Transplantados , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Feminino , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
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