Outbreak of resistant Acinetobacter baumannii: measures and proposal for prevention and control

Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

Adesão à higienização das mãos entre a equipe multiprofissional de uma unidade de terapia intensiva infantil - um estudo transversal e descritivo / Handwashing adhesion between the multiprofissional team of the infantile intensive care unit. Descriptive study

Objetivou-se avaliar a adesão das equipes médica, de enfermagem, fisioterapia, técnico de radiologia e técnico de laboratório à higienização das mãos (HM) na Unidade de Terapia Intensiva Infantil de um hospital universitário. Realizou-se um estudo transversal em agosto de 2005, com observação direta e estratificada por profissional, turno de trabalho e contatos com paciente, objetos, mobiliário, etc, estes últimos considerados como oportunidades de HM. Em1.164 observações a taxa global de adesão à HM foi baixa. As maiores taxas foram no período noturno (31,1% antes e 42,7% após contatos), entre as equipes médica (39,8%) e de enfermagem (34,0%); por profissionais, foram o enfermeiro (45,3%) e médico preceptor (44,9%). A menor adesão foi dos técnicos de radiologia, auxiliares de enfermagem e médicos externos à UTI. Sugerem-se investimentos em programas educativos visando a incorporação do conhecimento e o aumento da adesão à HM entre a equipe multiprofissional.

It was objectified to evaluate the physician, nursering, physiotherapy, radiology technicist and laboratory technicist team adhesion to the hand hygiene in the infantile intensive care unit of an university hospital. It was realizaed a transversal and descriptive study in August, 2005, with direct and stractificated professional observation, work shift and pacient contacts, objects, furniture, etc, the last considered like hand hygiene opportunities. In 1.164 observations the global rate of adhesion to the hand hygiene was low. The majority were in the night shift (31,1% before and 42,7% after contacts), between physician team (39,8%) and nursering (34,0%); as for professionals were the nurse (45,3%) and preceptor physician (44,9%). The minor adhesion was of the radiology technicists, nursering assistants and intensive care external physicians. Investments are suggested in educative programs seeking the knowledge incorporation and the adhesion enhance to the hand hygiene between healthcare workers team.

Perfil de sensibilidade em infecções pneumocócicas e análise da conduta terapêutica em hospital de referência em doenças infecciosas / Management of pneumococal infectious according to the sensibility profile in a state reference hospital for infectious disease

Com o advento da resistência do Streptococcus pneumoniae (pneumococo) à penicilina, o tratamento empírico inicial tornou-se complexo, sendo fundamental a determinação do perfil de sensibilidade em cada instituição, visando à adequada abordagem terapêutica deste agente. Objetivo: Analisar, em hospital de referência em doenças infecciosas, a conduta terapêutica instituída diante das infecções por Streptococcus pneumoniae, avaliando a influência do conhecimento do perfil de sensibilidade deste agente e das condições clínicas dos pacientes. Método: Estudo observacional de crianças hospitalizadas no Centro Geral de Pediatria (FHEMIG-BH), no período de 2000 a 2001. Resultado: Isolou-se o pneumococo em 33 crianças (57,6% com pneumonia e 42,4% com meningite). A infecção por pneumococo resistente à penicilina (MIC≥2,0 mg/ml) ocorreu em 9,1%, nos quais o tratamento foi modificado diante da piora clínica e do padrão de sensibilidade. Em 27,3% dos casos, isolou-se cepa com sensibilidade intermediária (MIC:0,1 a 1,0 mg/ml). Entre estes, 55,6% mantiveram o tratamento com penicilina na dose habitual, com boa evolução clínica. Nos demais com sensibilidade intermediária, houve alteração da antibioticoterapia. Cepas de pneumococos foram sensíveis (MIC≥ 0,06 mg/ml) em 63,6% das infecções e o uso da penicilina obteve bons resultados. Conclusões: A prevalência de cepas resistentes foi relativamente baixa (9,1%). Dos pacientes infectados por pneumococos com sensibilidade intermediária à penicilina, 55,6% apresentaram resposta clínica satisfatória com dose habitual deste antibiótico.

Management of pneumococcal infections according to the sensibility profile in State reference hospital for infectious disease. In troduction: The prevalence of infections due to Streptococcus pneumoniae with reduced susceptibiliry to penicillin is increasing what makes the empiric treatment a complex issue. Each institution should determine the sensibililty profile of this bacteria to estabilish the best management of these infections. Objectives: To know, in a State reference hospital for infectious disease, the sensibility profile of S. pneumoniae and to estabilish its correlation with clinical aspects. Methods: retrospective study of inpatients in Centro Geral de Pediatria (CGP - FHEMIG- Brazil) during the period of 2000 to 2001. Results: Pneumococcus was isolated in 33 children; 57.6% with pneumonia and 42.4% with meningitis. Penicillin resistant pneumococci (MIC > 2 µg/mIL were found in 9.1%. The therapy was changed according to the sensibility profile and clinical course of the illness. In 27.3% of the children, S. pneumoniae with reduced susceptibility to penicillin (MIC 0.1- 1,0 µg/mL) was isolated: 55.6% of the patients improved with penicillin in usual doses and the others had the antibiotic changed. In 63.6% of the patients. S. pneumoniae was sensitive to penicillin (MIC< 0.1µg/mL.]). Most of them used penicillin and the outcome was uneventful. Conclusions: The prevalence of penicillin resistant pneumococcus was relatively low (9.1%). Most patients with infections with pneumococcus with reduced susceptibility to penicillin (55.6%) got well using the standard therapy with this antibiotic.