RESUMO
OBJECTIVE: To compare the clinical characteristics and outcomes of patients with community-acquired and hospital-acquired sepsis. METHODS: This is a retrospective cohort study that included all patients with a diagnosis of sepsis detected between January 2010 and December 2015 at a private hospital in southern Brazil. Outcomes (mortality, intensive care unit and hospital lengths of stay) were measured by analyzing electronic records. RESULTS: There were 543 hospitalized patients with a diagnosis of sepsis, with a frequency of 90.5 (85 to 105) cases/year. Of these, 319 (58%) cases were classified as hospital-acquired sepsis. This group exhibited more severe disease and had a larger number of organ dysfunctions, with higher hospital [8 (8 - 10) versus 23 (20 - 27) days; p < 0.001] and intensive care unit [5 (4 - 7) versus 8.5 (7 - 10); p < 0.001] lengths of stay and higher in-hospital mortality (30.7% versus 15.6%; p < 0.001) than those with community-acquired sepsis. After adjusting for age, APACHE II scores, and hemodynamic and respiratory dysfunction, hospital-acquired sepsis remained associated with increased mortality (OR 1.96; 95%CI 1.15 - 3.32, p = 0.013). CONCLUSION: The present results contribute to the definition of the epidemiological profile of sepsis in the sample studied, in which hospital-acquired sepsis was more severe and was associated with higher mortality.
OBJETIVO: Comparar as características clínicas e os desfechos de pacientes com sepse adquirida na comunidade ou no hospital. MÉTODOS: Trata-se de estudo retrospectivo de coorte, que incluiu todos os pacientes com diagnóstico de sepse detectada entre janeiro de 2010 e dezembro de 2015 em um hospital privado localizado na Região Sul do Brasil. Os desfechos (mortalidade, tempo de permanência na unidade de terapia intensiva e no hospital) foram avaliados por meio da análise dos registros eletrônicos. RESULTADOS: Foram hospitalizados, no total, 543 pacientes com diagnóstico de sepse, com frequência de 90,5 (85 a 105) casos por ano. Destes, 319 (58%) casos foram classificados como sepse adquirida no hospital. Este grupo apresentava doença mais grave e tinha um maior número de disfunções de órgãos, assim como teve um tempo maior de permanência no hospital [8 (8 - 10) versus 23 (20 - 27) dias; p < 0,001] e na unidade de terapia intensiva [5 (4 - 7) versus 8,5 (7 - 10); p < 0,001] do aqueles que apresentavam sepse adquirida na comunidade. Após ajustar quanto à idade, escore APACHE II e disfunção hemodinâmica e respiratória, a sepse adquirida no hospital persistiu associada com maior mortalidade (OR 1,96; IC95% 1,15 - 3,32, p = 0,013). CONCLUSÃO: Nossos resultados contribuem para a definição do perfil epidemiológico da sepse na amostra estudada, na qual a sepse adquirida no hospital foi mais grave e associada com mortalidade mais alta.
Assuntos
Infecção Hospitalar/fisiopatologia , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/fisiopatologia , APACHE , Idoso , Brasil , Estudos de Coortes , Infecção Hospitalar/mortalidade , Feminino , Hospitais Privados , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/mortalidadeRESUMO
RESUMO Objetivo: Comparar as características clínicas e os desfechos de pacientes com sepse adquirida na comunidade ou no hospital. Métodos: Trata-se de estudo retrospectivo de coorte, que incluiu todos os pacientes com diagnóstico de sepse detectada entre janeiro de 2010 e dezembro de 2015 em um hospital privado localizado na Região Sul do Brasil. Os desfechos (mortalidade, tempo de permanência na unidade de terapia intensiva e no hospital) foram avaliados por meio da análise dos registros eletrônicos. Resultados: Foram hospitalizados, no total, 543 pacientes com diagnóstico de sepse, com frequência de 90,5 (85 a 105) casos por ano. Destes, 319 (58%) casos foram classificados como sepse adquirida no hospital. Este grupo apresentava doença mais grave e tinha um maior número de disfunções de órgãos, assim como teve um tempo maior de permanência no hospital [8 (8 - 10) versus 23 (20 - 27) dias; p < 0,001] e na unidade de terapia intensiva [5 (4 - 7) versus 8,5 (7 - 10); p < 0,001] do aqueles que apresentavam sepse adquirida na comunidade. Após ajustar quanto à idade, escore APACHE II e disfunção hemodinâmica e respiratória, a sepse adquirida no hospital persistiu associada com maior mortalidade (OR 1,96; IC95% 1,15 - 3,32, p = 0,013). Conclusão: Nossos resultados contribuem para a definição do perfil epidemiológico da sepse na amostra estudada, na qual a sepse adquirida no hospital foi mais grave e associada com mortalidade mais alta.
ABSTRACT Objective: To compare the clinical characteristics and outcomes of patients with community-acquired and hospital-acquired sepsis. Methods: This is a retrospective cohort study that included all patients with a diagnosis of sepsis detected between January 2010 and December 2015 at a private hospital in southern Brazil. Outcomes (mortality, intensive care unit and hospital lengths of stay) were measured by analyzing electronic records. Results: There were 543 hospitalized patients with a diagnosis of sepsis, with a frequency of 90.5 (85 to 105) cases/year. Of these, 319 (58%) cases were classified as hospital-acquired sepsis. This group exhibited more severe disease and had a larger number of organ dysfunctions, with higher hospital [8 (8 - 10) versus 23 (20 - 27) days; p < 0.001] and intensive care unit [5 (4 - 7) versus 8.5 (7 - 10); p < 0.001] lengths of stay and higher in-hospital mortality (30.7% versus 15.6%; p < 0.001) than those with community-acquired sepsis. After adjusting for age, APACHE II scores, and hemodynamic and respiratory dysfunction, hospital-acquired sepsis remained associated with increased mortality (OR 1.96; 95%CI 1.15 - 3.32, p = 0.013). Conclusion: The present results contribute to the definition of the epidemiological profile of sepsis in the sample studied, in which hospital-acquired sepsis was more severe and was associated with higher mortality.
Assuntos
Humanos , Masculino , Feminino , Idoso , Infecção Hospitalar/fisiopatologia , Mortalidade Hospitalar , Sepse/fisiopatologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Brasil , Infecção Hospitalar/mortalidade , Estudos Retrospectivos , Estudos de Coortes , Hospitais Privados , Sepse/mortalidade , APACHE , Tempo de Internação , Pessoa de Meia-IdadeRESUMO
Complications in hospitalized trauma patients are major causes of morbidity and mortality. The aims of this study were to identify the in-hospital trauma patients' complications and identify the risk factors for complications in this population. A retrospective analysis was conducted in a sample from a Brazilian hospital. The sample consisted of 407 patients, 194 (47.66%) of whom had records of complications. The most common complications were infections (41.80%). The risk factors related to the complications were age, length of hospital stay, external causes, and injury severity. The complications were frequent in this sample, and the risk for complications was characterized by multiple factors.
Assuntos
Mortalidade Hospitalar , Tempo de Internação , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto , Fatores Etários , Brasil , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/fisiopatologia , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospital in Mexico. METHODS: We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS: During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS: RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.
Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/fisiopatologia , Vírus Sincicial Respiratório Humano/patogenicidade , Adolescente , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/fisiopatologia , Infecção Hospitalar/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Infecções por Vírus Respiratório Sincicial/virologia , Adulto JovemRESUMO
A pesar de las numerosas investigaciones realizadas en torno a la sepsis, la morbilidad y mortalidad elevadas por su causa revelan un insuficiente conocimiento al respecto, que impide en muchos casos identificar oportunamente sus manifestaciones clínicas y pone en riesgo la supervivencia de los niños hospitalizados; razón por la cual se impone aumentar y actualizar el volumen de información que posee el personal de la salud encargado de atender a la población infantil ingresada en instituciones sanitarias pediátricas. Para ello se revisaron los resultados de discusiones médicas en conferencias de consensos internacionales, donde se debatió acerca de importantes aspectos epidemiológicos, fisiopatológicos y clínicos relacionados con el asunto, siempre con el propósito de disminuir la incidencia de ese factor de riesgo.
Despite the numerous researches on sepsis, the high morbidity and mortality because of it reveal a lack of knowledge about it, which prevents in many cases timely identification of its clinical manifestations and threatens the survival of hospitalized children; reason why it should be increased and updated the volume of information that the people in charge of health care for children admitted to pediatric health institutions have. With this purpose the results of medical discussions on international consensus conferences were reviewed, where important epidemiological, pathophysiological and clinical aspects related to the subject were discussed, always with the aim of reducing the incidence of this risk factor.
Assuntos
Humanos , Masculino , Hospitais Pediátricos , Mortalidade Infantil , Infecção Hospitalar/fisiopatologia , Infecções/epidemiologia , Fatores de Risco , Atenção Secundária à SaúdeRESUMO
Los pacientes internados en hospitales, principalmente aquellos que se encuentran severamente enfermos, son más susceptibles a las infecciones por hongos oportunistas, en comparación con la población general. El personal hospitalario puede ser fuente potencial de infección para estos pacientes, ya que normalmente actúa como portador de gérmenes, que eventualmente podrían ser transmitidos a los pacientes. Se describe, en esta investigación, el aislamiento de hongos levaduriformes a partir de las manos y la cavidad oral, en un grupo de 77 trabajadores del Hospital San Juan de Dios, en servicios donde se han reportado más casos de infecciones por este tipo de hongos. Métodos: Se realizó un hisopado de cavidad oral y manos de cada participante y se cultivaron placas con agar glucosado de Sabouraud (AGS) y Mycosel. A los aislamientos de levaduras se les determinó la capacidad de crecimiento a 37 grados centígrados, resistencia a la cicloheximida, producción de tubo germinativo, fosfolipasas y proteinasas y se determinó la sensibilidad in vitro al fluconazol por medio de método de microdilución en placa. Resultados: El 72,7 por ciento de los participantes resultaron positivos para el aislamiento de levaduras, la especie aislada con mayor frecuencia fue candida parapsilosis, seguida de C. albicans y C. famata. La mayor positividad se obtuvo en el servicio de cirugía 3, 83.3 por ciento, seguido de la UCI, 71.4 por ciento y neonatología, 58 por ciento. Conclusión: Estos resultados instan a mejorar las acciones preventivas en el manejo de los pacientes, a ser más estrictos en las normas de higiene de manos y promover, en otros centros hospitalarios, la realización de este tipo de estudios, para disminuir los brotes nosocomiales por transmisión horizontal.
Critically ill patients are more susceptible than the general populationto opportunistic fungal infections. Health workers could be a potential infectious focus to these patients. Thus in this investigation we report the isolation of yeast from the hands and oral cavity in a group of 77 employees of the San Juan de Dios Hospital from Services where infecctionsdue to these fungi had previously been reported. Methods: Samples from oral cavity and both hands were taken from 77 individuals. Each sample was platted into Sabouraud´s dextrose agar and Mycosel agar. Each yeast isolate wasanalyzed for growth capacity at 37°C, cycloheximide resistance, germ tube formation, phospholipase and proteinase production. Further, in vitro susceptibility testing of each isolate tofluconazol was performed using a microdilution method. Results: A 72.7% yeast positivity was found in all samples taken. Candida parapsilosis was themost frequent isolate, followed by C. albicans and C. famata. The ward with the greatest positivity was Surgery 3 (83.3%), followed by Intensive Care Unit (71.4%) and Neonatology (58%).Conclusion: These findings suggest that strict aseptic handling of patients should be observed to avoid horizontal transmission of yeasts in these wards. Similar studies should be conduced inothers hospitals.
Assuntos
Humanos , Candida , Infecção Hospitalar/etiologia , Infecção Hospitalar/fisiopatologia , Recursos Humanos em Hospital , Categorias de Trabalhadores , LevedurasRESUMO
Se realizó un estudio descriptivo retrospectivo en el Hospital Clinicoquirúrgico Hermanos Ameijeiras, en el período comprendido entre el 1º de abril y el 31 diciembre de 2006 para hacer una caracterización clínica de los pacientes que adquirieron neumonía nosocomial en las unidades de atención al paciente grave. Se confeccionó un modelo de recogida de datos, los cuales se obtuvieron de las historias clínicas y de los protocolos de necropsias. Se efectuó el cálculo de porcentajes y la prueba de chi cuadrado de Pearson para el análisis de los datos. Se registraron 727 ingresos en ese período, y de ellos 107 (14,7 por ciento) adquirieron neumonía nosocomial. Se halló que el grupo de edad más afectado fue el de los mayores de 60 años (69,1 por ciento), el mayor porcentaje de enfermos fueron hombres (53,3 por ciento) y el 62,8 por ciento adquirió la neumonía en las primeras 72 h de estadía en la unidad. Se identificaron como más frecuentes, los antecedentes patológicos personales siguientes: hipertensión arterial (53,2 por ciento), diabetes mellitus (25,2 por ciento) y cardiopatía isquémica (19,6 por ciento). Hubo asociación estadísticamente significativa entre el uso de la ventilación mecánica y el fallecimiento de los pacientes (p= 0,001). No se halló asociación estadísticamente significativa entre los trastornos de la conciencia y el tiempo de estadía con el estado al egreso (p=0,77 y p=0,28, respectivamente). Se aislaron más frecuentemente los gérmenes: Staphylococcus aureus (62,5 por ciento), Acinetobacter (40,9 por ciento) y Klebsiella neumoniae (38,6 por ciento). Se concluyó que la causa directa de muerte en el 60,8 por ciento de los pacientes fue la neumonía nosocomial.
A descriptive and retrospective study was conducted in Hermanos Ameijeiras Clinical and Surgical Hospital from April 1 to December 31, 2006, to make a clinical characterization of the patients that acquired nosocomial pneumonia in the acute care units. A model to collect data was designed. The data were obtained from the medical histories and the necropsy protocols. The calculation of percentages and Pearson's chi square test were used to analyze data. 727 admissions were registered in that period, and 107 of them (14.7 percent) acquired nosocomial pneumonia. The group over 60 (69.1 percent) was the most affected. The highest percentage of sick individuals were males (53.3 percent), whereas 62.8 percent acquired pneumonia in the first 72 hours of stay at the unit. The following personal pathological histories were the most frequent: arterial hypertension (53.2 percent), diabetes mellitus (25.2 percent) and ischemic heart disease (19.6 percent). There was a statistically significant association between the use of mechanical ventilation and the patients' death (P 0.001). No marked statistically association was found between the consciousness disorders and the stay length with the state on discharge (p 0.77 and p 0.28, respectively). Staphylococcus aureus (62.5 percent), acinetobacter (40.9 percent) and Klebsiella neumoniae (38.6 percent) were the most frequently isolated germs. It was concluded that nosocomial pneumonia was the direct cause of death in 60.8 percent of the patients.
Assuntos
Humanos , Cuidados Críticos , Infecção Hospitalar/fisiopatologia , Pneumonia/fisiopatologiaRESUMO
Justificación y objetivos: La producción de B-lactamasas es uno de los principales mecanismos de resistencia a antibióticos utilizados por las bacterias Gram negativas. A partir de los años 80 se describe en Escherichia coli y Klebsiella pneumoniae un nuevo tipo de estas enzimas, las B-lactamasas de espectro ampliado (BLEA) que inactivan todos los antibióticos B-lactámicos, con excepción de los carbapenémicos. Su diseminación global ha sido muy rápida, lo que ha creado problemas terapéuticos importantes. Este trabajo tiene como objetivos el análisis de la frecuencia de las infecciones producidas por estas bacterias en pacientes internados en el Hospital San Juan de Dios (HSJD), los factores de riesgo para su adquisición y el análisis molecular de las enzimas identificadas...
Assuntos
Humanos , beta-Lactamases , Escherichia coli , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/etiologia , Infecção Hospitalar/fisiopatologia , Klebsiella pneumoniae , Fatores de Risco , Costa RicaRESUMO
BACKGROUND: Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI). We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa. METHODS: We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI. RESULTS: The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score (SAPS II), were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC) curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51-70.49) and APACHE II (OR: 12.51, CI95% 3.12-50.09) on day -1 were the best predictors for mortality. CONCLUSION: SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI.
Assuntos
Bacteriemia/fisiopatologia , Infecção Hospitalar/fisiopatologia , Infecções por Pseudomonas/fisiopatologia , Pseudomonas aeruginosa , Índice de Gravidade de Doença , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Curva ROCRESUMO
Although there are numerous studies of candidaemia in adults, data on paediatrics are still limited. The aim of this study was to compare risk factors, aetiology, therapy, and the outcome of nosocomial candidaemia among paediatric and adult patients in a large Brazilian tertiary hospital (1995-2003). During this period, 78 paediatrics and 113 adults were studied. Species other than Candida albicans caused 78.2% of episodes of candidaemia in paediatrics. Compared to adults, paediatrics received more frequently broad-spectrum antibiotics, vasopressors, blood transfusions, arterial catheter, chest tube, cardiothoracic surgery, mechanical ventilation, and parenteral nutrition. Candidaemia caused by Candida parapsilosis was more common in paediatrics, as was the isolation of Candida spp. from catheters. Amphotericin B treatment was more common in paediatrics. Mortality rate was higher in adults than in paediatrics with nosocomial candidaemia. We reinforce the necessity of continuous epidemiologic surveillance to follow the dynamics of candidaemia.