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1.
Int J Mol Sci ; 22(12)2021 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-34202945

RESUMO

Trillions of microbes exist in the human body, particularly the gastrointestinal tract, coevolved with the host in a mutually beneficial relationship. The main role of the intestinal microbiome is the fermentation of non-digestible substrates and increased growth of beneficial microbes that produce key antimicrobial metabolites such as short-chain fatty acids, etc., to inhibit the growth of pathogenic microbes besides other functions. Intestinal microbiota can prevent pathogen colonization through the mechanism of colonization resistance. A wide range of resistomes are present in both beneficial and pathogenic microbes. Giving antibiotic exposure to the intestinal microbiome (both beneficial and hostile) can trigger a resistome response, affecting colonization resistance. The following review provides a mechanistic overview of the intestinal microbiome and the impacts of antibiotic therapy on pathogen colonization and diseases. Further, we also discuss the epidemiology of immunocompromised patients who are at high risk for nosocomial infections, colonization and decolonization of multi-drug resistant organisms in the intestine, and the direct and indirect mechanisms that govern colonization resistance to the pathogens.


Assuntos
Antibiose , Suscetibilidade a Doenças , Microbioma Gastrointestinal , Interações Hospedeiro-Patógeno , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Peptídeos Catiônicos Antimicrobianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Resistência a Múltiplos Medicamentos , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Sepse/etiologia
2.
BMC Infect Dis ; 21(1): 693, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34281515

RESUMO

BACKGROUND: Nosocomial infections (NIs) are an important cause of mortality, and increasing evidence reveals that the prevalence of NIs can be reduced through effective prevention and control measures. The aim of this study was to investigate the impact of the prevention and control measures for the COVID-19 pandemic on NIs. METHODS: A retrospective study was conducted to analyze the prevalence of NIs before and after COVID-19 pandemic for 6 months in the Children's Hospital of Soochow University. RESULTS: A total of 39,914 patients in 2019 and 34,645 patients in 2020 were admitted to the hospital during the study. There were 1.39% (481/34645) of patients with NIs in 2020, which was significantly lower than the 2.56% (1021/39914) of patients in 2019. The rate of critical and fatal cases was also decreased. In addition, the rate of appropriate handwashing, the number of protective gloves and aprons used per person and the number of healthcare staff per patients were significantly increased. Except for the ICU, the prevalence of nosocomial infection in most departments decreased from 2019 to 2020. Regarding the source of infections, a significant reduction was mainly observed in respiratory (0.99% vs 0.42%, p = 0.000) and digestive tract (0.63% vs 0.14%, p = 0.000). The microorganism analysis of respiratory infections indicated an obvious decline in acinetobacters and fungi. The most significant decline of pathogens in gastrointestinal infections was observed for rotavirus. The comparison of catheter-related nosocomial infections between 2019 and 2020 did not show significant differences. CONCLUSIONS: The prevention and control measures for the COVID-19 pandemic have reduced the nosocomial infection in almost all departments, except the ICU, mainly regarding respiratory, gastrointestinal, and oral infections, while catheter-related infections did not show any differences.


Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/epidemiologia , SARS-CoV-2 , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , China/epidemiologia , Infecção Hospitalar/etiologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Masculino , Pandemias , Prevalência , Estudos Retrospectivos , Centros de Atenção Terciária
5.
Curr Opin Infect Dis ; 34(4): 365-371, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34010232

RESUMO

PURPOSE OF REVIEW: The coronavirus disease (COVID-19) pandemic has resulted in necessary modifications of infection control policies and practices in acute healthcare facilities globally. This is often accompanied by infrastructure modifications, ward redesignations, as well as healthcare staff redeployments and changes to infection prevention and control (IPC) practices. We review the potential for both negative and positive impacts these major changes can have on nosocomial transmission of multidrug-resistant organisms (MDROs). RECENT FINDINGS: Healthcare facilities around the world have reported outbreaks of MDROs during the COVID-19 pandemic. In contrast some centres have reported a decrease in baseline rates due to a number of possible factors. SUMMARY: While implementing crucial preventive measures for COVID-19, is it important to consider any collateral effects of changes in IPC and antimicrobial stewardship program (ASP) practices. The disruption caused to IPC and ASP practices during the pandemic are likely to see a counter intuitive increase in transmission of MDROs.


Assuntos
COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/transmissão , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , SARS-CoV-2 , Doença Aguda , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Surtos de Doenças , Hospitais , Humanos , Controle de Infecções/métodos , Pandemias , Vigilância em Saúde Pública
6.
Curr Opin Infect Dis ; 34(4): 333-338, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34039877

RESUMO

PURPOSE OF REVIEW: Mathematical, statistical, and computational models provide insight into the transmission mechanisms and optimal control of healthcare-associated infections. To contextualize recent findings, we offer a summative review of recent literature focused on modeling transmission of pathogens in healthcare settings. RECENT FINDINGS: The COVID-19 pandemic has led to a dramatic shift in the modeling landscape as the healthcare community has raced to characterize the transmission dynamics of SARS-CoV-2 and develop effective interventions. Inequities in COVID-19 outcomes have inspired new efforts to quantify how structural bias impacts both health outcomes and model parameterization. Meanwhile, developments in the modeling of methicillin-resistant Staphylococcus aureus, Clostridioides difficile, and other nosocomial infections continue to advance. Machine learning continues to be applied in novel ways, and genomic data is being increasingly incorporated into modeling efforts. SUMMARY: As the type and amount of data continues to grow, mathematical, statistical, and computational modeling will play an increasing role in healthcare epidemiology. Gaps remain in producing models that are generalizable to a variety of time periods, geographic locations, and populations. However, with effective communication of findings and interdisciplinary collaboration, opportunities for implementing models for clinical decision-making and public health decision-making are bound to increase.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Modelos Teóricos , COVID-19/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Suscetibilidade a Doenças , Humanos , Aprendizado de Máquina , Pandemias , Vigilância em Saúde Pública
7.
Rofo ; 193(5): 537-543, 2021 05.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33694146

RESUMO

PURPOSE: The recent COVID-19 pandemic has resulted in an increasing overload of the medical system. Healthcare workers (HCW) in radiology departments are exposed to a high infection risk similar to HCWs in the ICU or dedicated COVID wards. The goal of our paper is to evaluate the prevalence of IgG antibody against SARS-CoV-2 among radiology HCWs in two different hospitals and regions in Germany with a low and high COVID-19 prevalence and to compare it to the prevalence in other clinical personnel. Additionally, we assessed the number of radiological procedures performed in patients with a positive PCR test (C+) followed by a short review of the risk for nosocomial infections of radiology HCWs. MATERIALS AND METHODS: During the first COVID-19 wave between March and July 2020, we evaluated a region with one of the highest COVID-19 rates (776-1570/100 000) in Germany (Hospital A). Additionally, we assessed Hospital B in a region with a low prevalence (65/100 000). We tested the serum prevalence of SARS-CoV-2 IgG antibodies among the whole staff with a subgroup analysis for radiology in both hospitals. We calculated the total number of different radiological procedures performed in C+ patients. RESULTS: In Hospital A 594 PCR-proven C+ patients were treated resulting in 2723 radiological procedures. 24 % (n = 6) of the radiology technicians and 13.35 (n = 2) of radiologists had a positive IgG test. The rates were similar to positive rates in HCWs in COVID-19 wards and ICUs within the hospital. The most frequently performed procedures in C+ patients were chest X-rays (3.17/patient) and CT examinations (1.15/patient). In Hospital B 50 C+ patients were treated, resulting in 64 radiological procedures. None of the HCWs tested IgG positive. The most frequently performed examinations were also chest X-rays (1.04/patient) and CT (0.2/patient). CONCLUSION: HCWs in radiology have a high occupational infection risk similar to that of HCWs in ICUs and dedicated COVID wards. KEY POINTS: · The risk of acquiring COVID-19 increases with the amount of contact with infected individuals.. · The occupational risk of a SARS-CoV-2 infection for radiology staff is similar to that of nurses and physicians in COVID wards.. · Hygiene concepts and medical resources have to be adapted for further COVID outbreaks.. · Reporting of an occupational disease can be considered in the case of seropositive staff.. CITATION FORMAT: · Finkenzeller T, Lenhart S, Reinwald M et al. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". Fortschr Röntgenstr 2021; 193: 537 - 543.


Assuntos
COVID-19/transmissão , Infecção Hospitalar/etiologia , Doenças Profissionais/etiologia , Radiologistas , COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Estudos Transversais , Estudos de Avaliação como Assunto , Alemanha , Humanos , Doenças Profissionais/epidemiologia , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Risco
8.
BMC Infect Dis ; 21(1): 233, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639871

RESUMO

BACKGROUND: The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS: From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION: This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.


Assuntos
Hepatite B/epidemiologia , Serviço Hospitalar de Limpeza/estatística & dados numéricos , Eliminação de Resíduos de Serviços de Saúde/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Centros Comunitários de Saúde/estatística & dados numéricos , Infecção Hospitalar/sangue , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/sangue , Hepatite B/etiologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/fisiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Resíduos de Serviços de Saúde/efeitos adversos , Resíduos de Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Exposição Ocupacional/análise , Logradouros Públicos/estatística & dados numéricos , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
9.
Medicine (Baltimore) ; 100(4): e24162, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530207

RESUMO

ABSTRACT: Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Fatores Etários , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Índice de Massa Corporal , Creatinina/sangue , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
11.
Transfusion ; 61(2): 641-648, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33616945

RESUMO

BACKGROUND: Pathogen reduction technology and enhanced bacterial culture screening promise to significantly reduce the risk of transfusion-associated septic reactions due to contaminated platelets. Recent reports suggest that these interventions lack efficacy for post-collection and processing contamination with environmental organisms if the storage bag integrity is compromised. CASE REPORT: We report a fatal septic transfusion reaction in a 63-year-old patient with chronic kidney and liver disease who received a pathogen reduced platelet transfusion in anticipation of surgery. METHODS: The residual platelet concentrate was cultured, with the detected microorganisms undergoing 16S genotype sequencing. Separate pathogen reduction studies were performed on the recovered bacteria, including assessment for amotosalen photoproducts. The storage container was subjected to pressure testing and microscopic examination. Environmental culture screening was performed at the hospital. RESULTS: Gram negative rods were detected in the platelet unit and cultures of both platelet component and the patient's blood grew Acinetobacter baumannii complex, Leclercia adecarboxylata and Staphylococcus saprophyticus. These strains were effectively inactivated with >7.2, 7.7, and >7.1 log10 kill, respectively. The platelet storage container revealed a leak visible only on pressure testing. Hospital environmental cultures were negative and the contamination source is unknown. A. baumannii complex and S. saprophyticus 16S genotyping sequences were identical to those implicated in a previously reported septic reaction. CONCLUSION: Findings are compatible with post-processing environmental contamination of a pathogen reduced platelet concentrate via a non-visible, acquired storage container leak. Efforts are warranted to actively prevent damage to, and detect defects in, platelet storage containers, and to store and transport components in clean environments.


Assuntos
Infecções por Acinetobacter/etiologia , Coinfecção/etiologia , Infecção Hospitalar/etiologia , Infecções por Enterobacteriaceae/etiologia , Contaminação de Equipamentos , Falha de Equipamento , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas/instrumentação , Sepse/etiologia , Infecções Estafilocócicas/etiologia , Reação Transfusional/etiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Plaquetas/microbiologia , Patógenos Transmitidos pelo Sangue/efeitos dos fármacos , Patógenos Transmitidos pelo Sangue/efeitos da radiação , Coinfecção/microbiologia , Infecção Hospitalar/microbiologia , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Evolução Fatal , Furocumarinas , Fraturas do Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus saprophyticus/isolamento & purificação , Trombocitopenia/complicações , Trombocitopenia/terapia , Reação Transfusional/microbiologia , Raios Ultravioleta
12.
Ann Hematol ; 100(3): 753-761, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33439306

RESUMO

Adenovirus (ADV)- or BK virus (BKV)-associated hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Several risk factors have been previously reported; however, it is unclear whether virus-associated HC can be transmitted. To clarify this point, we performed a retrospective cohort study on 207 consecutive patients who underwent allo-HSCT at Kyoto University Hospital between 2012 and 2018. We evaluated the incidence and risk factors of virus-associated HC and performed a phylogenetic analysis of the ADV partial sequence. The median age at transplantation was 50 (range, 17-68) years. Fifty-eight patients (28%) developed HC. ADVs were detected in 18 cases, BKVs were detected in 51, both were detected in 12, and only John Cunningham virus (JCV) was detected in 1 case. No factor was significantly associated with HC. However, both ADV- and BKV-HC occurred intensively between April 2016 and September 2017, which suggested possible nosocomial transmission of ADV and BKV. Genome sequencing of the hexon, E3, and penton regions of detected ADVs identified 7 cases of ADV type 11, 2 cases of type 35, and 3 cases of a type 79-related strain. A sequence analysis revealed that these strains in each type were almost identical, except for one case of a type 79-related strain. In conclusion, ADV-HCs with possible nosocomial transmission were described based on genotyping of the virus and partial sequencing of the viral genome. Although viral HC after allo-HSCT is thought to mainly be due to reactivation of a latent virus, nosocomial transmission of ADV or BKV should also be considered.


Assuntos
Infecção Hospitalar/etiologia , Cistite/virologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/virologia , Viroses/etiologia , Adenoviridae/isolamento & purificação , Adenoviridae/fisiologia , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/etiologia , Adolescente , Adulto , Idoso , Vírus BK/isolamento & purificação , Vírus BK/fisiologia , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Cistite/epidemiologia , Cistite/etiologia , Feminino , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Vírus JC/isolamento & purificação , Vírus JC/fisiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Polyomavirus/epidemiologia , Infecções por Polyomavirus/etiologia , Estudos Retrospectivos , Fatores de Risco , Transplante Homólogo/efeitos adversos , Transplante Homólogo/estatística & dados numéricos , Infecções Tumorais por Vírus/epidemiologia , Infecções Tumorais por Vírus/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Viroses/epidemiologia , Adulto Jovem
13.
J Clin Immunol ; 41(3): 515-525, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33387156

RESUMO

PURPOSE: The SARS-CoV-2 infection can lead to a severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation and high mortality rate. Interestingly, COVID-19-associated ARDS share biological and clinical features with sepsis-associated immunosuppression since lymphopenia and acquired infections associated with late mortality are frequently encountered. Mechanisms responsible for COVID-19-associated lymphopenia need to be explored since they could be responsible for delayed virus clearance and increased mortality rate among intensive care unit (ICU) patients. METHODS: A series of 26 clinically annotated COVID-19 patients were analyzed by thorough phenotypic and functional investigations at days 0, 4, and 7 after ICU admission. RESULTS: We revealed that, in the absence of any difference in demographic parameters nor medical history between the two groups, ARDS patients presented with an increased number of myeloid-derived suppressor cells (MDSC) and a decreased number of CD8pos effector memory cell compared to patients hospitalized for COVID-19 moderate pneumonia. Interestingly, COVID-19-related MDSC expansion was directly correlated to lymphopenia and enhanced arginase activity. Lastly, T cell proliferative capacity in vitro was significantly reduced among COVID-19 patients and could be restored through arginine supplementation. CONCLUSIONS: The present study reports a critical role for MDSC in COVID-19-associated ARDS. Our findings open the possibility of arginine supplementation as an adjuvant therapy for these ICU patients, aiming to reduce immunosuppression and help virus clearance, thereby decreasing the duration of mechanical ventilation, nosocomial infection acquisition, and mortality.


Assuntos
Arginina/metabolismo , COVID-19/complicações , Linfopenia/etiologia , Células Supressoras Mieloides/fisiologia , Síndrome do Desconforto Respiratório/imunologia , SARS-CoV-2 , Idoso , Infecção Hospitalar/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/metabolismo , Índice de Gravidade de Doença
15.
Infect Control Hosp Epidemiol ; 42(4): 406-410, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32895065

RESUMO

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). METHODS: We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility-associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. RESULTS: In total, 2,337 patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). CONCLUSIONS: The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.


Assuntos
COVID-19/complicações , Infecções por Clostridium/etiologia , Infecção Hospitalar/etiologia , Idoso , Antibacterianos/uso terapêutico , COVID-19/prevenção & controle , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia
16.
Int J Lab Hematol ; 43(2): 244-249, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33099872

RESUMO

INTRODUCTION: Metagenomic Next-Generation Sequencing (mNGS) is an emerging technique for microbial identification and diagnosis of infectious diseases. The clinical utility of mNGS, especially its real-world impact on antimicrobial treatment and patient outcome has not been systematically evaluated. METHODS: We prospectively assessed the effectiveness of mNGS in 70 febrile inpatients with suspected infections at Hematology department of the Children's Hospital, National Clinical Research Center for Child Health. 69/70 patients were given empirical antibiotics prior to mNGS. A total of 104 samples (62 plasma, 34 throat swabs, 4 bone marrow, 4 bronchoalveolar lavage) were collected on day 1-28 (mean 6.9) following symptom onset and underwent mNGS testing. RESULTS: Traditional microbiological tests discovered causal microorganisms in 5/70 (7.14%) patients, which were also detected by mNGS. In addition, mNGS reported possible pathogens when routine tests were negative. Antibiotics were adjusted accordingly in 55/70 (78.6%) patients that led to improvement/relief of symptoms within 3 days. In contrast, mNGS results were considered irrelevant in 15/70 (21.4%) patients by a board of clinicians, based on biochemical, serological, imaging evidence, and experiences. CONCLUSION: mNGS expanded the capacity of pathogen detection and made a positive impact on clinical management of suspected infections through (a) differential diagnosis which may rule out infectious diseases and (b) adjustment or de-escalation of empirical antibiotics.


Assuntos
Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/etiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/etiologia , Sequenciamento de Nucleotídeos em Larga Escala , Metagenoma , Metagenômica , Adolescente , Biomarcadores , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Gerenciamento Clínico , Suscetibilidade a Doenças , Feminino , Doenças Hematológicas/complicações , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Masculino , Metagenômica/métodos
17.
Obstet Gynecol ; 137(1): 139-145, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33278290

RESUMO

OBJECTIVE: To test the hypothesis that digital placement of a balloon catheter is not inferior to the speculum method in terms of rate of maternal infection. METHODS: In an open-label noninferiority randomized trial, pregnant women who were undergoing induction of labor with unfavorable cervix (less than 3 cm dilated and less than 60% effaced) were randomly assigned to balloon catheter that was placed either digitally or using a sterile speculum. The primary outcome was a composite of maternal infection, defined by occurrence of fever (temperature 38°C or higher), chorioamnionitis, or endometritis (diagnoses were made by the managing obstetric physician or midwife). Prespecified secondary outcomes included outcomes in the primary composite, cesarean delivery rates, and maternal and neonatal outcomes. A patient satisfaction survey was also obtained. On the basis of a noninferiority margin of 10% and an expected primary outcome frequency of 10%, a sample size of 372 women was needed (90% power to confirm noninferiority with 90% protocol adherence). RESULTS: From February 2018 through February 2019, 372 women were randomized (185 digital placement, 187 sterile speculum). Baseline characteristics were similar between groups. The composite maternal infection rate was not different between groups (digital placement arm: 15.7% vs speculum arm: 12.8%), with an absolute difference with respect to the sterile speculum arm of 2.8% (95% CI -4.3 to 9.9%), indicating noninferiority for the prespecified margin. Secondary outcomes were not different between groups, except for a higher need for a second balloon catheter in the sterile speculum arm. Maternal and neonatal adverse events were not different between groups. Irrespective of method of placement, women were equally satisfied with the explanation of the method before placement, anxiety regarding the procedure, and pain during placement. More women in the sterile speculum group would choose the digital placement method for the subsequent pregnancy (37.6% vs 25.7%; P=.02.). CONCLUSION: Digital placement of a balloon catheter for preinduction cervical ripening is noninferior to the sterile speculum method, in terms of maternal infection. Women in the sterile speculum group more frequently required a second round of the mechanical dilator. The blind digital approach is a reasonable option for balloon placement for cervical ripening. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03450408.


Assuntos
Maturidade Cervical , Infecção Hospitalar/etiologia , Trabalho de Parto Induzido/efeitos adversos , Complicações Infecciosas na Gravidez/etiologia , Adulto , Feminino , Humanos , Trabalho de Parto Induzido/instrumentação , Trabalho de Parto Induzido/métodos , Gravidez , Instrumentos Cirúrgicos , Adulto Jovem
19.
Int J Mol Sci ; 21(24)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33352868

RESUMO

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 µm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a "One wipe, One surface, One direction, Dispose" policy should be implemented and rigorously enforced.


Assuntos
Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Desinfetantes/administração & dosagem , Desinfecção , Ambiente de Instituições de Saúde , Desinfecção/métodos , Desinfecção/normas , Ambiente de Instituições de Saúde/normas , Humanos
20.
Leuk Res ; 99: 106463, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33130331

RESUMO

BACKGROUND: Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality. PATIENTS-METHODS: We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files. RESULTS: There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival. CONCLUSION: Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.


Assuntos
Enterococcus faecium/efeitos dos fármacos , Neutropenia Febril/complicações , Infecções por Bactérias Gram-Positivas/etiologia , Leucemia Mieloide Aguda/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Resistência a Vancomicina , Adulto , Fatores Etários , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Daptomicina/uso terapêutico , Enterococcus faecium/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Linezolida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/microbiologia , Turquia/epidemiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia , Vancomicina/farmacologia , Vancomicina/uso terapêutico
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