ABSTRACT
Several epidemiological changes have occurred in the pattern of nosocomial and community acquired infectious diseases during the past 25 years. Social and demographic changes possibly related to this phenomenon include a rapid population growth, the increase in urban migration and movement across international borders by tourists and immigrants, alterations in the habitats of animals and arthropods that transmit disease, as well as the raise of patients with impaired host defense abilities. Continuous surveillance programs of emergent pathogens and antimicrobial resistance are warranted for detecting in real time new pathogens, as well as to characterize molecular mechanisms of resistance. In order to become more effective, surveillance programs of emergent pathogens should be organized as a multicenter laboratory network connected to the main public and private infection control centers. Microbiological data should be integrated to guide therapy, adapting therapy to local ecology and resistance patterns. This paper presents an overview of data generated by the Division of Infectious Diseases, Federal University of São Paulo, along with its participation in different surveillance programs of nosocomial and community acquired infectious diseases.
Várias alterações epidemiológicas ocorreram no perfil das doenças infecciosas hospitalares e comunitárias nos últimos 25 anos. Mudanças sociais e demográficas possivelmente relacionadas com esse fenômeno incluem o rápido crescimento populacional, o aumento da migração urbana e deslocamento através de fronteiras internacionais por turistas e imigrantes, alterações nos habitats de animais e artrópodes que transmitem doença assim como o aumento no número de pacientes com deficiências nas respostas de defesa. Os programas contínuos de vigilância de patógenos emergentes e resistência antimicrobiana são necessários para a detecção em tempo real de novos patógenos assim como para caracterizar mecanismos moleculares de resistência. Para serem mais efetivos, os programasde vigilância dos patógenos emergentes devem ser organizados em uma rede de laboratórios multicêntricos ligados aos principais centros de controle de infecções, públicos e privados. Os dados microbiológicos devem ser integrados a guias terapêuticos adaptando práticas terapêuticas à ecologia local eaos padrões de resistência. O artigo apresenta uma revisão dos dados gerados pela Disciplina de Infectologia, Universidade Federal de São Paulo, contemplando sua participação nos diferentes programas de vigilância de doenças infecciosas hospitalares e adquiridas na comunidade.
Subject(s)
Humans , Communicable Diseases, Emerging , Community-Acquired Infections , Cross Infection , Drug Resistance, Bacterial , Drug Resistance, Fungal , Drug Resistance, Viral , Brazil , Communicable Diseases, Emerging/microbiology , Communicable Diseases, Emerging/prevention & control , Communicable Diseases, Emerging/virology , Community-Acquired Infections/microbiology , Community-Acquired Infections/prevention & control , Community-Acquired Infections/virology , Cross Infection/microbiology , Cross Infection/prevention & control , Cross Infection/virology , Drug Resistance, Bacterial/drug effects , Drug Resistance, Bacterial/genetics , Drug Resistance, Fungal/drug effects , Drug Resistance, Fungal/genetics , Drug Resistance, Viral/drug effects , Drug Resistance, Viral/genetics , HIV-1 , Hospitals, University , Population SurveillanceABSTRACT
Handwashing compliance was compared at two medical- surgical intensive care units (ICUs) of a teaching and a non-teaching hospital. The mean compliance was 22.2 percent and 42.6 percent, respectively. Respiratory therapists at the non-teaching hospital had the best handwashing compliance (52.6 percent). Nursing assistants at the teaching hospital had the worst compliance (11.5 percent). Nursing assistant was the only health-care worker category with a significant difference between the two ICUs (odds ratio = 6.0; 95 percent confidence interval = 3.83-9.43; p< 0.001).
Subject(s)
Humans , Cross Infection/prevention & control , Guideline Adherence/statistics & numerical data , Hand Disinfection , Intensive Care Units/statistics & numerical data , Personnel, Hospital , Brazil , Hospitals, TeachingABSTRACT
Background: The National Nosocomial Infections Surveillance System (NNIS system) is the method for surveying nosocomial infections used by the Centers for Disease Control (CDC). This strategy allows the comparison of different hospitals, using rate adjustments. In Chile, this system is not used. Aim: To report the application of this system in a tertiary reference hospital in Chile. Materials and methods: We performed a six months prospective cohort study. The active surveillance was carried out by using the intensive care unit and surgery components of the NNIS system. Tabulation and analysis of the data were done according to the NNIS system. In a parallel prevalence study, we determined the NNIS system sensitivity to detect nosocomial infections. Results: A total of 492 patients were followed with a global nosocomial infection rate of 14 per cent, for discharged patients. The calculated sensitivity and specificity of the system was 84.2 and 97 per cent respectively. In the intensive care unit, 45 of 169 patients had nosocomial infections, with an adjusted rate of 2.8 per cent for mean hospitalization time and severity of illness. In the cardiovascular and thoracic surgical units, 216 and 107 procedures were surveyed, respectively. The global rates of nosocomial infections were 7.4 and 7.5 per cent, respectively. The adjusted rates according to risk factors were 0.9 and 2.3 per cent, respectively. Conclusions: These data indicate that the surgical units had surgical site infections rates similar to those reported by the CDC. Nosocomial infections rates in Chile can be compared with rates observed in other countries. The epidemiological data collected can be useful to focus intervention or preventive strategies
Subject(s)
Humans , Communicable Disease Control , Cross Infection/epidemiology , Epidemiological Monitoring , Outcome and Process Assessment, Health CareABSTRACT
Objetivo: Determinar a eficácia e segurança do tratamento empírico com a cefepima em infecçöes moderadas do trato respiratório inferior e do trato urinário superior. Local: Hospital Universitário de 600 leitos. Desenho do estudo: Estudo clínico aberto, näo-comparativo. Causuística: Foram avaliados 27 pacientes adultos com infecçäo do trato respiratório inferior e do trato urinário superior que requereram hospitalizaçäo e tratamento empírico. Pacientes neutropênicos foram excluídos. O acompanhamento foi realizado até a alta hospitalar. Foram analisadas as respostas ao tratamento do ponto de vista clínico e microbiológico. Resultados: Vinte e sete pacientes foram analisados, no período de 3/95 a 12/96. A idade média foi de 40,5 anos e pacientes do sexo feminino foram os mais prevalentes, 17 (63 por cento). As infecçöes responsáveis pelas hospitalizaçöes foram: pneumonia (14), pielonefrite (11) e bronquite (2). A média do tempo de hospitalizaçöes foi de 14 dias. Dezesete pacientes eram portadores de doença de base no momento da admissäo ao hospital. Bactérias consideradas como agentes causadores da infecçäo foram isoladas em 25 pacientes, todas suscetíveis à cefepima; P.aeruginosa (4), A.baumanii (2), entre outras. A cura microbiológica foi obtida em todos os pacientes, e a cura clínica em 26. Um doente apresentou cura parcial. Nenhum efeito adverso grave foi encontrado. Um paciente apresentou febre persistente que resolveu com a suspensäo do antibiótico e um paciente apresentou leucopenia leve, näo necessitando suspender o tratamento