Pediatric mortality due to nosocomial infection: a critical approach

Nosocomial infection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomial infection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomial infection and mortality and pediatrics/neonate/ newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomial infection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE) II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomial infection can be reduced and health care quality improved in pediatric hospitals.

O papel das comissões de controle de infecções hospitalares / The role of the infection-control commitee

A infecção hospitalar é importante problema de saúde pública. Exigências legais reforçam o interesse pelo estabelecimento de programas de controle. Dados coletados sistematicamente, analisados e devolvidos para o corpo clínico, fazem com que todos se motivem para enfrentar seriamente o problema. Diante da necessidade de se conhecerem indicadores, melhorar a prática assistencial, padronizar medicamentos e materiais médico-hospitalares, realizar educação continuada, elaborar guias e protocolos e gerenciar "pela qualidade", equilibrando múltiplos interesses divergentes, enquadram-se as Comissões de Controle de Infecções Hospitalares - comitês de profissionais constituídos de uma equipe multidisciplinar. Urge que se redefina o termo infecção hospitalar para mantê-lo coerente com o seu significado atual. A idéia que ele traduz é a de infecção relacionada à assistência - onde quer que ela seja prestada. Cabe à CCIH conhecer a epidemiologia da instituição, controlar infecção cruzada e manter programa que promova a melhoria da qualidade assistencial e educacional: a proteção do paciente e circunstantes; a redução dos custos da assistência, financeiro e social: da dor, sofrimento, agravos psicológicos e morte. As CCIH, em integração com a Vigilância Sanitária, poderão transformar o momento da vistoria do estabelecimento em salutar troca de educação em saúde. O esforço ,dessas duas instâncias poderá ser potencializado, no sentido de alcançarem a efetividade para a melhoria da qualidade assistencial no município de Belo Horizonte. É fundamental que todos os profissionais entendam que a prevenção e o controle de infecções são questão de cidadania e direitos humanos: dependem muito mais deles próprios do que das leis que se lhes impõem. A transformação da organização é responsabilidade de todos.

Nosocomial infection is an important public health problem. Legal requirements enforces the expectation that hospitals establish formal infection control programs. Systematically collected and analyzed data on cross-infection rates showed to clinicians motivates everybody to seriously address the problem. Since it is necessary to know outcomes, to improve the quality of health care, to standardize medicines and medical supplies and equipments, to perform continuous education, to make guidelines and to manage using continuous quality improvement tools - balancing many different wishes, the infection control committee is established - being a multidisciplinary teamwork. It is high time to make the words hospital infection more understandable to present days! It means infection associated to the health care - wherever it is provided. The professional staff committees must know the epidemiology of the medical center, take prevention measures and perform a program to enhance the quality of health care and health education, to protect patients and stand-bys, to reduce health care financial and social costs; and the pain, distress, psychological harms and death. The infection control committee and the health surveillance team can exchangeknowledge on health education during the e latter work on accreditation of hospitals. In would function as a task force to improve the quality of health care in the city of Belo Horizonte. It is a key point to understand that prevention and control of nosocomial infections is much more a matter of citizenship and human rights than that of legal issues. The transformation of the organization is everybody's job!

Isolamento de microrganismos em infecções bacterianas comunitárias e hospitalares no Centro Geral de Pediatria e compatibilidade com o tratamento / Isolated agents of nosocomial and comunnity bacterial infections in Centro Geral de Pediatria (pediatrics general center) and its treatment compatibility

Objetivo: Avaliar os agentes bacterianos isolados em culturas e sua sensibilidade aos antimicrobianos (ATB) inicialmente empregados. Métodos: Todas as crianças internadas no Centro Geral de Pediatria- FHEMIG de fevereiro/99 à julho/99 com diagnóstico de provável infecção bacteriana (segundo evidências clínicas, laboratoriais, radiológicas ou microbiológicas) ou com diagnóstico de infecção bacteriana hospitalar (segundo critérios do Centre for Disease Contral - USA (CDC) e do Ministério da Saúde) foram analisadas. Resultados: Foram analisados 336 prontuários médicos de 330 pacientes. Foram diagnosticadas 351 infecções, sendo 17 hospitalares. Prevaleceram as infecções respiratórias, sendo 153 casos de pneumonia. Os ATB mais usados foram as aminopenicilinas. A modificação da terapêutica foi feita principalmente em bases clínicas. A sensibilidade das culturas foi de 17,2%. Embora tenham sido isolados oito microorganismos resistentes, apenas quatro tiveram o ATB modificado de acordo com o antibiograma. Conclusões: O isolamento de bactérias foi menor que o desejado, mas a coleta de amostras para culturas é muito importante para o isolamento do agente causal e para o manejo clínico do paciente.

Objective: To evaluate isolated bacterial agents in cultures and their sensitiviry to the antimicrobians (ATB) used. Methods: All children admitted to the hospital from february to july/99 with probable diagnosis of bacterial infection (according to clinical, laboratorial, radiological or microbiological evidences) or with nosocomial infection (according to CDC and the Brazilian Healthy Ministry criteria) were evaluated. Results: There were 336 admissions and 330 patients. There were 351 bacterial infections, from which 17 were nosocomial infections. The respiratory tract infections prevailed, with 153 cases of pneumonia. The most used ATB were the aminnopenicilins. The therapeutical approach varied primarily according to clinical evaluation. The sensitivity of cultures was 17,2%. Even though 8 resistent microorganisms were isolated, only 4 had their ATB modified following their antibiogram. Conclusions: The number of isolated bacteria was less than expected. Nevertheless, the collection of cultures are of great importance to isolate the casual agent and to direct the clinical management.