RESUMO
Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem.Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil.Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections.Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed.Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3â%, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3â%), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs.Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.
Assuntos
Infecção Hospitalar , Pneumonia , Sepse , Humanos , Adulto , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Unidades de Terapia IntensivaRESUMO
INTRODUCTION: The frequency of methicillin-resistant Staphylococcus aureus (MRSA) has increased in the community. This study evaluated the prevalence of MRSA and community-acquired (CA)-MRSA in 120 healthy elderly. METHODS: The MRSA were evaluated for the presence of the IS256, mecA, agr, icaA, icaD, fnbB , and pvl genes with PCR. RESULTS: Frequency of S. aureus and MRSA colonization was 17.8% and 19%, respectively. CA-MRSA isolate showed SCC mec IV, fnbB+ , and icaD+ . CONCLUSIONS: CA-MRSA was detected, with genotype determined as SCC mec type IV/IS256/ fnbB+ / icaA / icaD+ / bbp-/agr2 / bap / pvl, characterizing this population as a possible reservoir of this organism in the community.
Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Idoso , Idoso de 80 Anos ou mais , Brasil , Infecções Comunitárias Adquiridas/microbiologia , Estudos Transversais , Feminino , Genes Bacterianos/genética , Genótipo , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases) by oxacillin-resistant S. aureus (ORSA) and (controls) oxacillin-sensitive S. aureus (OSSA) from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD)/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1%) patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4%, corresponding to 63.5% for ORSA and 36.5% for OSSA. The risk of illness for this organism was significant (p<0.05), regardless of whether colonization/infection was by ORSA or OSSA. The consumption of antibiotics was high, mainly for broad-spectrum cephalosporins (551.26 DDDs/1,000 patient-days). The high density of use of glycopeptides (269.56 DDDs/1,000 patient-days) was related to colonization by ORSA (Pearson r=0.57/p=0.02). Additionally, age >60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.
Assuntos
Antibacterianos/uso terapêutico , Orofaringe/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Adulto , Brasil , Estudos de Casos e Controles , Feminino , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Fatores de RiscoRESUMO
The objectives of this study were to investigate the participation of Candida albicans and non-albicans as colonization and sepsis agents, along with the risk factors associated with the neonates in the neonatal intensive care unit of the clinical hospital of the Federal University of Uberlândia. Epidemiological surveillance was implemented through the National Healthcare Safety Network between August 2007 and April 2008. The incidence rate for sepsis with microbiological criteria was 6.7/1,000 patients/day, which was shown as only one case of candidemia. Approximately 19% of the neonates were colonized by Candida, which was identified as Candida albicans (50%) and Candida not-albicans (50%). The significant risk factors for Candida spp colonization were gestational age of between 26 and 30 weeks, previous antibiotic use and umbilical central vascular catheter. The overall mortality among the neonates hospitalized with sepsis over the study period was 11.8%. However, the neonate with candidemia did not die.
Assuntos
Antifúngicos/farmacologia , Candida/isolamento & purificação , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva Neonatal , Brasil , Candida/classificação , Candidíase/epidemiologia , Candidíase/mortalidade , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Fungemia/microbiologia , Hospitais de Ensino , Humanos , Incidência , Recém-Nascido , Testes de Sensibilidade Microbiana , Fatores de Risco , Vigilância de Evento Sentinela , Sepse/epidemiologia , Sepse/microbiologiaRESUMO
Hand hygiene is a primary mechanism for reducing contact transmission of infectious agents. We evaluated the efficacy of hand hygiene agents under condition in which they are currently being used by healthcare workers. A total of forty Healthcare Workers (HCWs) and office workers in a teaching hospital washed their hands with procedures using soap and water, and alcohol-based gel, with and without standardized protocols. A total numbers of colony - forming units on the hands were 3.52 and 4.48 for the HCWs and non-patient staff hands, respectively (p< 0.05). The average reduction in the number of organisms before and after hand hygiene of any procedures showed always statistically significant differences by both standardized and non-standardized procedures, and they all demonstrated similar results when compared to each other, with only two exceptions. There was no difference in the proportion of HCWs or non-patient staff with Staphylococcus aureus and Gram- negative rods on their hands. This study demonstrated that the regular usage of alcohol gel is as good as handwashing with soap and water, and could increase compliance in the hand hygiene, especially in situations where there is a lack of sinks or HCWs are overworked.
Assuntos
Controle de Infecções , Infecção Hospitalar , Desinfecção das MãosRESUMO
Staphylococci are a common cause of catheter-related bloodstream infection (CR-BSI), and epidemiological typing is an important tool for effective infection control. This study evaluated by PFGE and rep-PCR whether Staphylococcus aureus strains isolated from skin and catheter tips were related to specimens isolated from blood. A prospective observational study, carried out in a clinical surgical ward at a Brazilian hospital between September 2000 and November 2002, investigated non-tunneled central venous catheters from 179 patients. S. aureus isolates were mainly obtained from blood (41.4%), while coagulase-negative staphylococci strains were more often isolated from the skin at the catheter insertion site (49.7%) and from the catheter tip (57.5%). Among the 21 strains isolated from 9 patients at 2 or 3 sites simultaneously, 9 were methicillin-resistant S. aureus (MRSA) and 12 were methicillin-susceptible S. aureus (MSSA). Seven patients harbored the same S. aureus strain isolated from the skin, blood and/or catheter tip cultures. MRSA isolates belonged to one PFGE pattern (type A- subtypes A(1), A(2) and A(3)), and to two rep-PCR patterns (a and b). MSSA isolates were distinguished in five PFGE (B to F) and in three rep-PCR (c, d and e) patterns. Both PFGE and rep-PCR methods indicated that the skin at the catheter insertion site was the origin of CR-BSI caused by S. aureus.