ABSTRACT
Objetivos: descrever a evolução dos pacientes com diagnóstico de hepatite viral B ou C submetidos a transplante de fígado em serviço de referência. Métodos: trata-se de estudo transversal realizado no Serviço de Transplante de Órgãos do Instituto Alfa de Gastroenterologiado Hospital das Clínicas da Universidade Federal de Minas Gerais, de 2005 a 2007. Os dados foram coletados em prontuários médicos e bancos de dados do serviço.Resultados: de 173 pacientes submetidos a transplante de fígado, 61 apresentavam hepatite C, nove tinham hepatite B e um evoluiu com hepatite A fulminante. Entre os pacientes com hepatite C, 31 receberam tratamento antes do transplante (sete com respostavirológica sustentada). Apenas dois pacientes com hepatite B foram tratados previamente.Após transplante hepático, a recidiva da hepatite ocorreu em 21 pacientes com hepatite C e nenhum com hepatite B. O tratamento medicamentoso após transplante hepático foirealizado em 13 de 21 dos pacientes com recidiva de hepatite C. Discussão: após transplante hepático em casos de cirrose pelo vírus da hepatite C, a recorrência da infecção é comum e indica necessidade de tratamento efetivo. A sobrevida pós-transplante em pacientes infectados pelo vírus da hepatite B depende da prevenção com uso da profilaxiacombinada. Conclusão: as hepatites virais respondem por importante proporção das indicações de transplante de fígado. A recidiva da hepatite C persiste como o principal problema nos pacientes transplantados por hepatites virais. A profilaxia da recidiva da hepatite B pós-transplante é mandatória com imunoglobulina e análogos de nucleosídeos.
Objectives: to describe the evolution of patients with a diagnosis of viral hepatitis B or C undergoing liver transplantation at a reference hospital. Methods: this was a cross-sectional study conducted in the Organ Transplantation Service of the Alfa Institute of Gastroenterology,General Hospital, Federal University of Minas Gerais, from 2005 to 2007. Data were collected from medical records and service databases. Results: out of 173 patients undergoing liver transplantation, 61 had hepatitis C, nine had hepatitis B, and one developed fulminant hepatitis A. Among patients with hepatitis C, 31 were treated before the transplantation(seven with sustained virological response). Only two patients with hepatitis B were pretreated. After liver transplantation, the recurrence of hepatitis occurred in 21 patients with hepatitis C, and in none with hepatitis B. The drug treatment after liver transplant was performedin 13 out of 21 patients with recurrent hepatitis C. Discussion: in cases of cirrhosis caused by the hepatitis C virus, recurrence of infection is common after liver transplantation and indicates the need for an effective treatment. Post-transplant survival in patients infectedwith hepatitis B virus depends on prevention using combined prophylaxis. Conclusion: viral hepatitis accounts for a significant proportion of indications for a liver transplant.Recurrence of hepatitis C persists as a major problem in transplanted patients due to viral hepatitis. Prophylaxis ofhepatitis B post-transplant recurrence is mandatory withimmunoglobulin and nucleoside analogs.
ABSTRACT
BACKGROUND: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE: To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS: This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS: During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). CONCLUSIONS: Shortening time on parenteral nutrition whenever possible and preference ...
Subject(s)
Female , Humans , Infant, Newborn , Male , Bacteremia/etiology , Cross Infection/etiology , Surgical Procedures, Operative/adverse effects , Bacteremia/diagnosis , Bacteremia/prevention & control , Case-Control Studies , Cross Infection/diagnosis , Cross Infection/prevention & control , Intensive Care Units, Neonatal , Risk FactorsABSTRACT
OBJETIVO: avaliar a implantação de vigilância ativa pós-alta de infecções de ferida cirúrgica (IFC) pós-cesariana na Maternidade Otto Cirne, município de Belo Horizonte, estado de Minas Gerais, Brasil. MÉTODOS: estudo observacional prospectivo, realizado de março/2010 a março/2011; os dados foram obtidos por vigilância ativa, realizada pela Comissão de Controle de Infecção Hospitalar, incluindo contato telefônico seguido de avaliação clínica quando necessária; a notificação seguiu critérios do National Healthcare Safety Network. RESULTADOS: identificaram-se 762 pacientes submetidas a cesariana (29,3 por cento) e fez-se contato telefônico com 500 puérperas; 7 IFC foram notificadas por vigilância passiva (0,9 por cento) e 34 por vigilância ativa (6,8 por cento), com aumento significativo do número de casos identificados (p<0,0001). CONCLUSÃO: a notificação de maior número de casos de IFC pós-cesariana por vigilância ativa reforça a necessidade da identificação de casos de infecção de sítio cirúrgico para reduzir a subnotificação, com referência de puérperas para assistência quando necessário, para definição diagnóstica e tratamento adequado.
OBJECTIVE: to evaluate the implementation of active surveillance post-discharge of Cesarean Surgical- Wound Infections(SWI) at Otto Cirne Maternity, Belo Horizonte, state of Minas Gerais, Brazil. METHODS: prospective observational study conducted from March 2010-2011; data was obtained by active surveillance performed by the Hospital Infection Control Committee, including telephone call followed by clinical evaluation when necessary; notification was performed according to National Healthcare Safety Network criteria. RESULTS: 762 patients who underwent cesarean section (29.3 per cent) were identified and 500 women were contacted; 7 SWI were notified by passive surveillance (0.9 per cent) and 34 by active surveillance (6.8 per cent), with a significant increase on identified cases (p<0.0001). CONCLUSION: notification of number of cases of SWI post-cesarean section by active surveillance emphasizes the need to identify cases of surgical-wound infection to reduce underreporting, referring to postpartum care when necessary for a definitive diagnosis and appropriate treatment.