Factores de riesgo de la neumonía intrahospitalaria en la unidad de cuidados intensivos del Hospital Guayaquil Dr. Abel Gilbert Pontón 2017-2018 / Risk factors that affect the increase of intrahospital pneumonia in the intensive care unit of the Guayaquil Dr. Abel Gilbert Pontoon Hospital 2017-2018

La neumonía intrahospitalaria es la segunda infección más frecuente, considerada un problema de salud pública. Su continuidad aumenta como consecuencia de los avances tecnológicos de la medicina. El objetivo del estudio es determinar los factores de riesgo que inciden en el incremento de neumonía intrahospitalaria en pacientes adultos de la Unidad de Cuidados intensivos del Hospital de Especialidades Dr. Abel Gilbert Pontón. El diseño del estudio corresponde a una investigación de tipo cuantitativa, descriptiva de corte transversal, la muestra estuvo conformada por 135 pacientes de la Unidad de Cuidados Intensivos del dicho hospital, la técnica empleada a partir de la observación es la recolección de información utilizando como instrumento una ficha o hoja de recolección de datos obtenidos de las historias clínicas de los pacientes. Los principales resultados muestran un 98% de gérmenes de tipo Gram negativas, siendo los que predominaron las Pseudomonas aeruginosa y Klebsiella pneumoniae, en los Gram positivos el Estaphilococos y Estreptococos. El tiempo de estadía del paciente en la UCI fue de 17 a 21 días y los factores de riesgo que incidieron en el incremento de neumonía intrahospitalaria, fueron la ventilación mecánica, el uso de métodos invasivos, el tratamiento con antibióticos, el tiempo de estancia hospitalaria y la permanencia con los dispositivos invasivos de entubación endotraqueal. Como solución al problema encontrado en la investigación se propone diseñar un protocolo se seguimiento y control, el cual va dirigido a la prevención, disminución de la neumonía nosocomial asociada a los factores de riesgos evaluados en el estudio(AU)

In-hospital pneumonia is the second most frequent infection, considered a public health problem. Its continuity increases as part of the technological advances of medicine. The objective of the study is to determine the factors that influence the increase of in-hospital pneumonia in adult patients of the Intensive Care Unit of the Specialties Hospital Dr. Abel Gilbert Pontoon. The design of the study corresponds to a quantitative, descriptive cross-sectional investigation, the sample consisted of 135 patients from the Intensive Care Unit of the hospital, the technique used from the observation is the collection of information on how use as a tool a data sheet or data collection sheet of patients' medical records. The main results are shown in 98% of the negative grammars types, being those that predominate the Pseudomonas aeruginosa and Klebsiella pneumoniae, in the Gram positive the Staphylococci and Streptococci. The patient's stay in the ICU was from 17 to 21 days and the risk factors that influenced the increase in in-hospital pneumonia were mechanical ventilation, the use of invasive methods, treatment with antibiotics, length of hospital stay. And the permanence with the invasive devices of endotracheal intubation. As a result of the investigation, it is a monitoring and control protocol, which is aimed at prevention, the reduction of pneumonia and the risk factors evaluated in the study(AU)

Prevalence and factors associated with group B streptococcal colonization in pregnant women / Prevalência e fatores associados a colonização por estreptococo do grupo B em gestantes

Abstract Objectives: to estimate the prevalence and the factors associated with the colonization by group B streptococcus (GBS) in pregnant women from the urban area attended at health units in a municipality in northeastern Brazil. Methods: it is a cross-sectional study conducted from January 2017 to March 2018. Vagino-rectal swabs were collected from 210 pregnant women between 32 and 40 weeks of gestation. The swabs were seeded on 5% sheep blood agar and on chromogenic agar. For confirmatory identification of GBS, the CAMP test and latex agglutination were used. Descriptive analysis and univariate and multivariate association analysis were performed using a multinomial logistic model. Results: the prevalence of GBS colonization among pregnant women was 18.1% (n = 38), and a statistically significant association (p<0.05) was found for income and parity variables in the group of older women in the univariate analysis, and for skin color, age and parity in the final multivariate analysis. Conclusions: the prevalence of maternal colonization by GBS was similar to that described in other studies. Although some risk factors, such as skin color, age and parity, were associated with colonization, other studies are essential to establish more information on pregnant women more likely to be colonized by GBS.

Resumo Objetivos: estimar a prevalência e apontar fatores associados à colonização por estreptococos do grupo B (EGB) em gestantes da zona urbana atendidas em unidades de saúde de um município do nordeste do Brasil. Métodos: trata-se de um estudo transversal realizado entre janeiro de 2017 a março de 2018. Foram coletados swabs vaginorretais de 210 gestantes entre a 32 e 40 semanas de gestação. As amostras foram semeadas em ágar sangue de carneiro 5% e ágar cromogênico. Para identificação confirmatoria de EGB foram utilizados o teste de CAMP e aglutinação em látex. Foram realizadas análise descritiva, de associação univariada e multivariada utilizando modelo logístico multinomial. Resultados: a prevalência de colonização por EGB entre as gestantes foi de 18,1% (n=38), e as variáveis renda e paridade no grupo de mulheres mais velhas na análise univariada além de cor da pele, idade e paridade na análise multivariada final estiveram estatisticamente associadas ao desfecho (p<0,05). Conclusões: a prevalência da colonização materna pelo EGB mostrou-se semelhante às descritas em outros estudos. Apesar de alguns fatores de risco como cor da pele, idade e paridade estarem associados à colonização, outros estudos são fundamentais para se estabelecer maiores informações sobre as gestantes mais passíveis de colonização pelo EGB.

Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization / Prevalência de colonização retovaginal por estreptococo do grupo B em gestantes de programa de atendimento pré-natal de instituição de saúde

ABSTRACT Objective To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.

RESUMO Objetivo Identificar a prevalência de estreptococo do grupo B entre gestantes que frequentaram um programa de saúde corporativa, bem como as correlações com a colonização positiva. Métodos Estudo retrospectivo dos prontuários do pré-natal de um hospital privado em São Paulo, no período de 2015 a 2016. Foram excluídas as mulheres que abandonaram o programa ou apresentavam dados incompletos nos prontuários. As variáveis quantitativas foram descritas por média, desvios padrão, mediana, valores mínimos e máximos. A paridade e a condição socioeconômica foram descritos por frequência absoluta e percentagens. Utilizamos modelos de regressão logística no programa (SPSS) para analisar as correlações de variáveis de acordo com a cultura retovaginal, considerando IC95% e valores de p. As variáveis foram idade, número de gestações, peso ganho na gestação e idade gestacional no parto. Resultados Foram incluídos 347 prontuários e, após a aplicação dos critérios de exclusão, 287 prontuários compuseram a amostra final. A idade dos pacientes variou entre 17 e 44 anos. A média de idade foi de 30,6 anos, e 67 pacientes tiveram resultado positivo para o estreptococo do grupo B (prevalência de 23,3%; IC95%: 18,7-28,5). Conclusão Considerando a alta prevalência de estreptococos do grupo B em nosso serviço, existem evidências de que a estratégia de antibiótico profilaxia baseada na cultura retovaginal é custo-efetiva.

Group B Streptococcus detection in pregnant women via culture and PCR methods

Abstract INTRODUCTION: Group B Streptococcus (GBS), a source of neonatal infection, colonizes the gastrointestinal and genitourinary tracts of pregnant women. Routine screening for maternal GBS in late pregnancy and consequent intrapartum antibiotic prophylaxis have reduced the incidence of early-onset GBS neonatal infection. The aim of this study was to evaluate the performance of PCR, compared to culture (gold standard), in GBS colonization screening of pregnant women, and to establish the prevalence of GBS colonization among this population. METHODS: Vaginal introitus and perianal samples were collected from 204 pregnant women, between the 35th and 37th weeks of pregnancy, at the Obstetrics and Gynecology Unit of the University of Caxias do Sul General Hospital between June 2008 and September 2009. All samples were cultured after enrichment in a selective medium and then assayed by culture and PCR methods. RESULTS: The culture and PCR methods yielded detection rates of vaginal/perianal GBS colonization of 22.5% and 26%, respectively (sensitivity 100%; specificity 95.6%; positive and negative predictive values 86.8% and 100%, respectively). A higher prevalence of GBS colonization was detected in the combined vaginal and perianal samples by both culture and PCR assay analyses. CONCLUSIONS: PCR is a faster and more efficient method for GBS screening, allowing for optimal identification of women who should receive intrapartum antibiotic prophylaxis to prevent newborn infection.

Colonización materna por streptococcus agalactiae (Sag) en Córdoba: aspectos epidemiológicos y microbiológicos

Marco Teórico: Entre las principales causas que explican la mortalidad en el recién nacido está las infecciones invasivas por Streptococcus agalactiae (Sag). En la patogénesis de la infección neonatal por Sag interviene la colonización asintomática del tracto genito-rectal de su madre así como los factores de virulencia bacterianos. Entre estos se destacan los antígenos polisacáridos (PLS) capsulares, que además permiten clasificar a Sag en serotipos (la Ib, II,III,IV,V,VI,VII,VIII, y IX). Diferentes estrategias de prevención se han implementado desde los '90. En nuestro país en el año 2008, la Ley Nacional 26.369 incorporó la modalidad de búsqueda universal en mujeres embarazadas y la administración de profilaxis intraparto (PIP) en casos positivos. Modalidad que tiene sus limitaciones, ya que solamente controla las infecciones de aparición temprana

Summary: Background: Invasive infections caused by Streptococcus agalactiae (Sag) constitute on of the main causes of mortality in newborn babies. Asymptomatic colonization of maternal genital and rectal tracts, as well as bacterial virulence factors, participates in the pathogenesis of neonatal infections by Sag. Among these it is important to highlight the presence of capsule polysaccharide (CPS) antigens, which in addition, allow classification of Sag into different serotypes (la Ib, II,II,IV,V,VI,VII,VIII and IX). Various prevention strategies have been implemented since the '90's. In Argentina, National Law 26369/2008 incorporated universal prenatal screening as well as the administration of intrapartum antibiotic prophylaxis (IAP) in positive cases. However, this procedure has some limitations since it only alloes to control early-onset Sag infections

Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo / Infective endocarditis in an internal medicine ward

Background: Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. Aim: To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. Material and methods: Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. Results: Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. Conclusions: A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary

Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population

The objective of this study was to determine the prevalence of maternal group B Streptococcal (GBS) colonization and compare risk factor data related to GBS colonization. A prospective surveillance study of 598 pregnant women was conducted in two socioeconomically diverse maternity hospitals in Ribeirão Preto, Brazil between June and October 1999. Swabs from the lower vagina were obtained between 35 and 37 weeks gestation and cultured on selective media. Risk factor data were obtained by patient interview and chart review. The overall maternal GBS colonization prevalence rate was 17.9 percent. There was no association of GBS colonization with maternity hospital and no association of GBS colonization with previously identified risk factors, such as age, race, martial status, maternal education, parity, smoking, or alcohol use. There is a relatively high prevalence of maternal GBS colonization in this Brazilian population, although previously-identified-risk factors were not found to be important. This study provides baseline data for the creation of community-based GBS disease prevention protocols.

Determinação de anti-estreptolisina "O" e proteína C reativa entre escolares do município de Laranjal, PR / Determination of antistreptolysin \"O\" and C-reactive protein among school children of Laranjal, PR

Para a determinação de anti-estreptolisina "O" e proteína C reativa, no município de Laranjal-PR, foram analisados soros de 411 escolares, entre 5 a 16 anos. Para anti-estreptolisina "O", 13,6 por cento tiveram títulos elevados e 5,1 por cento foram reativos para proteína C reativa. Não foram observadas diferenças em relação ao sexo e faixa etária.

Reporte de un brote de escarlatina / Report on a scarlet fever outbreak

Se conoció de la ocurrencia de casos sospechosos de escarlatina en un centro laboral, motivo por el cual se creó un equipo multidisciplinario para realizar el estudio y control correspondiente. Se realizó una encuesta a los trabajadores y se tomaron muestras de exudado faríngeo y de sangre para el título de antiestreptolisina O (TASO) en algunos casos. De 207 trabajadores encuestados, 129 (62,3 por ciento ) refirieron haber estado enfermos con un proceso respiratorio agudo inicial y de ellos, 41 (31,8 por ciento ) manifestaron síntomas cutáneos compatibles con escarlatina. Se aislaron 9 cepas de estreptococo betahemplítico del grupo A y 34 enfermos presentaron títulos de antiestreptolisina O elevada. La aparición de una cepa de estrptococo, al parecer de gran efectividad y toxigenicidad, en uan población adulta susceptible en condiciones laborales favorables a la transmisión respiratoria dio origen al brote