ABSTRACT
A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.
Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.
La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.
Subject(s)
Humans , Female , Urinary Tract Infections/complications , Urinary Tract Infections/mortality , Urinary Tract Infections/prevention & control , Urinary Tract Infections/drug therapy , Drug Resistance, Microbial/drug effects , Urinary Tract , Women , Ciprofloxacin/therapeutic use , Cross Infection/complications , Cross Infection/transmission , Escherichia coli/pathogenicity , Catheters/microbiology , Hand Hygiene , Ampicillin/therapeutic use , Intensive Care Units , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
The pathogenic and consistent effect of discrimination on mental health has been largely documented in the literature. However, there are few studies measuring multiple types of discrimination, evaluating the existence of a dose-response relationship or investigating possible effect modifiers of such an association. To investigate the association between experiences of discrimination attributed to multiple reasons and common mental disorders, including the adjustment for potential confounders, assessment of dose-response relations, and examination of effect modifiers in undergraduate students from southern Brazil. In the first semester of 2012, 1,023 students from the Universidade Federal de Santa Catarina answered a self-administered questionnaire on socio-demographic characteristics, undergraduate course, experiences of discrimination and common mental disorders. Associations were analyzed through logistic regression models, estimation of The study results showed that students reporting discrimination at high frequency and intensity were 4.4 (95%CI 1.6 - 12.4) times more likely to present common mental disorders. However, the relationship between discrimination and common mental disorders was protective among Electrical Engineering students, when compared to Accounting Sciences students who did not report discrimination. The findings suggest that the dose-response relationship between experiences of discrimination and common mental disorders reinforces the hypothetical causal nature of this association. Nevertheless, the modification of effect caused by the undergraduate course should be considered in future studies for a better understanding and measurement of both ...
O efeito deletério e consistente das experiências discriminatórias sobre a saúde mental tem sido amplamente documentado na literatura. No entanto, são escassos os trabalhos que aferem múltiplos tipos de discriminação, avaliam a existência de relação dose-resposta ou investigam possíveis modificadores de efeito dessa associação. Investigar a associação entre experiências discriminatórias por múltiplos motivos e sofrimento psíquico, incluindo a avaliação de efeito dose-resposta, o ajuste para potenciais confundidores e o exame de modificadores de efeito em estudantes universitários do sul do Brasil. No primeiro semestre de 2012, 1.023 graduandos da Universidade Federal de Santa Catarina responderam a um questionário autopreenchível sobre características sociodemográficas, curso de graduação, experiências discriminatórias e sofrimento psíquico. As associações foram analisadas com modelos de regressão logística, estimação de razões de chance e seus respectivos intervalos de confiança de 95% (IC95%). Observou-se que estudantes que relataram sofrer discriminação em alta frequência e intensidade apresentaram 4,4 (IC95% 1,6 - 12,4) vezes mais chance de apresentar sofrimento psíquico. Entretanto, a relação da discriminação com o sofrimento psíquico foi protetora em meio aos graduandos de Engenharia Elétrica, quando comparados aos de Ciências Contábeis não discriminados. A partir do estudo, concluiu-se que a relação dose-resposta entre experiências discriminatórias e sofrimento psíquico reforça a hipótese de natureza causal dessa associação. Contudo, a modificação de efeito ocasionada pelo curso de graduação deve ser considerada em investigações futuras para uma melhor compreensão de ambos os fenômenos e suas estratégias de mensuração.
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Antisepsis , Breast Neoplasms/surgery , Catheters/microbiology , Mammaplasty , Mastectomy , Surgical Wound Infection/prevention & control , Breast Neoplasms/complications , Breast Neoplasms/pathology , Catheters/adverse effects , Drainage/adverse effects , Follow-Up Studies , Neoplasm Staging , Postoperative Care , Prognosis , Prospective Studies , Surgical Wound Infection/etiologyABSTRACT
Fundamento En los últimos 20 años ha habido un cambio considerable en el rol de la traqueostomía en la edad pediátrica. La obstrucción de la vía aérea superior secundaria a infecciones dejó de constituir la causa más común de traqueostomía en el niño. Asimismo, las alteraciones estructurales de la vía aérea superior y la necesidad de asistencia ventilatoria prolongada o crónica se han convertido en las indicaciones más frecuentes de traqueostomías pediátricas.Objetivo Determinar la incidencia de la traqueostomía en nuestro medio, sus principales indicaciones, complicaciones e influencia en la mortalidad. MetodologíaSe realizó un estudio descriptivo retrospectivo de los pacientes que requirieron traqueostomía en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Docente José Martí de Sancti Spíritus, Cuba, en un período de diez años, desde 1999 hasta 2008. Resultados Fue necesario practicar traqueostomía a 14 (0,5 por ciento) pacientes del total de ingresados durante ese período, de ellos 9 (64,2 por ciento) eran menores de un año. La indicación más frecuente fue la necesidad de ventilación mecánica prolongada asociada a patología neurológica con 10 (71,42 por ciento) casos. Las malformaciones e infecciones agudas de las vías aéreas superiores constituyeron indicaciones poco frecuentes. Las principales complicaciones que se presentaron fueron infección en 10 (71,4 por ciento) casos y la obstrucción en 4 (28,5 por ciento), siendo aislados más comúnmente la Pseudomonas aeruginosa en seis (60 por ciento), el Staphylococcus aureus en tres (30 por ciento), la Klebsiella pneumoniae en tres (30 por ciento) y el Enterobacter cloacae en tres (30 por ciento). Además, cuatro (28,5 por ciento) pacientes fueron decanulados exitosamente, fallecieron cinco (35,7 por ciento) y sólo en uno (7,14 por ciento) la causa se relacionó con la traqueostomía.
Introduction There has been a significant change in the role of pediatric tracheostomy over the last twenty years. Obstruction of the upper airway caused by infectious agents is no longer the leading cause of tracheostomy in children. Structural anomalies of the upper airway as well as the need for prolonged ventilator assistance have become the most frequent indication for pediatric tracheostomy. ObjectiveThe purpose of this paper is to assess the incidence, indications, complications, and role in mortality of tracheostomy in our pediatric population. MethodsA retrospective descriptive study of pediatric patients who underwent tracheostomy was conducted between 1999 and 2008 in the Pediatric Intensive Care Unit of the José Martí de Sancti Spiritus Pediatric Teaching Hospital in Cuba. Results Tracheostomy was performed in 14 patients during the period of the study (0.5 percent of admitted patients). Nine of them (64.2 percent) were younger than one year. The most frequent indication for the procedure was the need for prolonged mechanical ventilation in patients with neurologic disorders in 10 patients (71.42 percent). Upper airway malformations and acute infections were infrequent indications for tracheostomy. The most frequent complications were infectious in 10 patients (71.4 percent) and obstruction in four patients (28.5 percent). The following germs were found: Pseudomona aeruginosa in six patients (60 percent), Staphylococcus aureus in three patients (30 percent), and Enterobacter cloacae in three patients (30 percent). Furthermore, four patients were successfully decannulated (28.5 percent), five patients died (35.7 percent) but only in one (7.14 percent), death could be attributed to tracheostomy. Conclusion The need for prolonged mechanical ventilation in patients with neurologic disorders was the main indication for tracheostomy in our pediatric population; most of these children were younger than one year. The procedure had little.
Subject(s)
Female , Infant , Child, Preschool , Child , Tracheostomy/statistics & numerical data , Intensive Care Units, Pediatric/statistics & numerical data , Age and Sex Distribution , Bacteria/isolation & purification , Cuba , Catheters/microbiology , Epidemiology, Descriptive , Hospitals, Pediatric , Patient Selection , Retrospective Studies , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Tracheostomy/mortalityABSTRACT
OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36%) of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82%) were more significantly involved than gram-negative ones (9.09%) and fungi (9.09%), with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.
Subject(s)
Catheters/microbiology , Equipment Contamination/statistics & numerical data , Fungi/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Syringes/microbiology , Drug Contamination , Drug Packaging , Fungi/classification , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , Hospitals, Teaching , IranABSTRACT
Purpose: Paired blood culture (PBC) is uncommon practice in hospitals in India, leading to delayed and inadequate diagnosis. Also contamination remains a critical determinant in hampering the definitive diagnosis. Objectives: To establish the need of PBC over single blood culture (SBC) along with the degree of contamination, this comparative retrospective study was initiated. Materials and Methods : We processed 2553 PBC and 4350 SBC in BacT/ALERT 3D (bioMerieux) between October 2010 and June 2011. The positive cultures were identified in VITEK 2 Compact (bioMerieux). True positivity and contaminants were also analyzed in 486 samples received from catheter and peripheral line. Results : Out of 2553 PBC samples, positivity was seen in 350 (13.70%). In 4350 SBC samples, positivity was seen in 200 samples (4.59%). In PBC true pathogens were 267 (10.45%) and contaminants were 83 (3.25%), whereas in SBC 153 (3.51%) were true positives and contaminants were 47 (1.08%). Most of the blood cultures (99.27 %) grew within 72 h and 95.8% were isolated within 48 h. In 486 PBCs received from catheter/periphery (one each), catheter positivity was found in 85 (true positives were 48, false positives 37). In peripheral samples true positives were 50 and false positives were 8. Conclusion: Significantly higher positive rates were seen in PBCs compared with SBCs. Automated blood culture and identification methods significantly reduced the time required for processing of samples and also facilitated yield of diverse/rare organisms. Blood culture from catheter line had higher false positives than peripheral blood culture. Thus every positive result from a catheter must be correlated with clinical findings and requires further confirmation.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Automation/methods , Bacteremia/diagnosis , Bacteriological Techniques/methods , Blood/microbiology , Catheters/microbiology , Child , Child, Preschool , Diagnostic Errors/statistics & numerical data , Female , Hospitals , Humans , India , Infant , Infant, Newborn , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Specimen Handling/methods , Time Factors , Young AdultABSTRACT
Staphylococcus epidermidis is a common pathogen in medical device-associated infections. Its major pathogenic factor is the ability to form adherent biofilms. In this work, three S. epidermidis strains isolated from infected catheters were chosen with the objective of investigating the effect of D-glucosamine (D-Glu) on reactive oxygen species (ROS) production, adhesion and biofilm formation. The chemiluminescence and nitroblue tetrazolium reduction assays were used to determine ROS production by planktonic S. epidermidis and the microtiter plate assay to quantify in vitro biofilm formation. D-Glu generated a dose-dependent increase in ROS in planktonic cells with maximum stimuli at a concentration of 0.05 mM, and reduced adhesion and biofilm formation. On the other hand, glucose showed an antioxidative stress action and promoted biofilm adhesion and growth. This study suggests a potential application of D-Glu against infections associated with indwelling medical devices, since the oxidative stress caused by this hexosamine in planktonic S. epidermidis contributed to reducing biofilm formation.
Staphylococcus epidermidis es un patógeno común en infecciones asociadas a dispositivos médicos. Su factor de patogenicidad más importante es la capacidad para formar biofilms. Se trabajó con tres cepas de S. epidermidis aisladas de catéteres, con las que se efectuaron ensayos de quimioluminiscencia y de reducción de azul de nitrotetrazolio, para determinar la producción de especies reactivas del oxígeno (ERO) en S. epidermidis planctónico, y ensayos dirigidos a cuantificar la formación de biofilm in vitro, empleando placas multipocillos. La D-glucosamina generó un aumento dependiente de la dosis en la producción de ERO en las células planctónicas, con un estímulo máximo a una concentración de 0,05 mM. Este aumento condμlo a la reducción de la adhesión y de la formación de biofilm. La adición de glucosa, en cambio, mostró un efecto anti estrés oxidativo y promovió la adhesión y el crecimiento de biofilm. Este estudio sugiere una posible aplicación de la D-glucosamina contra las infecciones asociadas a dispositivos médicos, ya que el estrés oxidativo provocado por esta hexosamina contribuyó a una menor formación de biofilm.
Subject(s)
Bacterial Adhesion/drug effects , Biofilms/drug effects , Glucosamine/pharmacology , In Vitro Techniques , Oxidants/pharmacology , Staphylococcus epidermidis/drug effects , Catheters/microbiology , Drug Evaluation, Preclinical , Equipment Contamination , Glass , Glucose/pharmacology , Oxidative Stress/drug effects , Polystyrenes , Staphylococcus epidermidis/isolation & purification , Staphylococcus epidermidis/physiologyABSTRACT
Background: Intravascular catheters and urinary catheters are an important source of hospital-acquired infections. Many microorganisms colonize indwelling catheters, including central venous catheters (CVCs) forming biofilms and cause infections that are difficult to treat. Although various methods have been employed to reduce biofilms, enzymes involved in bacterial cell wall synthesis could provide novel targets for the development of anti-biofilm agents. N-Acetylglucosamine-1-phosphate uridyltransferase (GlmU) is an essential enzyme in aminosugars metabolism and catalyzes the formation of uridine-diphospho-N-acetylglucosamine (UDP-GlcNAc), an important precursor in the peptidoglycan and lipopolysaccharide biosynthesis of Gram-positive and Gram-negative bacteria. Previous study has been conducted on the anti-biofilm effect of GlmU inhibitors such as N-ethyl maleimide (NEM) and NEM analogs along with a cationic polypeptide protamine sulfate (PS), which enhanced its anti-biofilm activity. AIM: The present study aimed at finding the effect of sub-inhibitory concentrations of N-ethyl maleimide (NEM) and protamine sulfate (PS) on the biofilms produced by Pseudomonas aeruginosa and Enterococcus spp. isolated from cases of catheter-associated UTI as well as Klebsiella pneumoniae and Staphylococcus aureus isolated from cases of catheter-related bloodstream infections (CRBSI). Materials and Methods: In order to enhance the activity of NEM and to develop a broad-spectrum anti-microbial composition, NEM (50 μg/ml) was combined with protamine sulfate (50 μg/ml) and tested for anti-biofilm activity using a standard quantitative biofilm assay method. Results and Conclusion: It was observed that NEM had no effect on the biofilm produced by Pseudomonas aeruginosa as well as by Enterococcus spp. NEM also caused a significant decrease in biofilm production by Staphylococcus aureus while it had no effect on the biofilm produced by Klebsiella pneumoniae. There was a significant synergistic inhibitory effect on Staphylococcus aureus and Enterococcus spp., whereas Pseudomonas aeruginosa and Klebsiella pneumoniae remained unaffected. Combination of GlmU inhibitor-plus-protamine sulfate failed to significantly reduce bacterial adherence of Pseudomonas aeruginosa and Klebsiella pneumoniae to catheter and cannula pieces, respectively. We found that the GlmU inhibitor was mainly effective in preventing the adherence and biofilm formation by gram-positive organisms. The combination of NEM and protamine sulfate may, therefore, be tried as anti-infective coatings for medical devices such as catheters and cannulas, and thus help in overcoming microbial resistance in the current era of increasing device-associated hospital infections.