ABSTRACT
Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.
The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.
Subject(s)
Humans , Laboratories, Hospital/standards , Cross Infection/diagnosis , Cross Infection/microbiology , Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms/complications , Biopsy/standards , Cross Infection/therapy , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapyABSTRACT
Resumen Introducción. El análisis de los costos derivados de las infecciones asociadas con la atención en salud representa un desafío para el sistema de salud en Colombia dados sus factores determinantes. Objetivo. Determinar los factores relacionados con el aumento y la variabilidad de los costos de la atención hospitalaria por las infecciones asociadas con la atención en salud en un hospital de cuarto nivel de Bogotá, entre el 2011 y el 2015. Materiales y métodos. Se analizaron los costos de la atención de 292 pacientes, los cuales se estimaron para cada una de las actividades realizadas desde el momento de sospechar el cuadro infeccioso hasta su resolución. Dichos costos se estandarizaron según el valor del manual tarifario del Instituto de Seguros Sociales, ajustándolos por el índice de precios al consumidor para salud hasta el año 2014. Se determinaron los factores relacionados con el aumento del costo del manejo mediante un modelo logístico condicional. Resultados. La estancia hospitalaria de nueve días o más antes de la infección, se asoció con el aumento del costo directo del manejo de las infecciones relacionadas con la atención en salud (odds ratio, OR=2,06; IC95% 1,11-3,63). El costo medio del manejo de las infecciones fue de COP $1.190.879. Los antibióticos representaron el 41 % del valor total del tratamiento, seguidos de los exámenes de laboratorio, con un costo equivalente al 13,5 %. Conclusión. Se encontró una relación entre el costo del manejo de las infecciones asociadas con la atención en salud y la estancia hospitalaria previa a su aparición. Los antecedentes patológicos de los pacientes no se relacionaron con el aumento de los costos.
Abstract Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cross Infection/economics , Hospital Costs , Time Factors , Case-Control Studies , Cross Infection/diagnosis , Cross Infection/therapy , Colombia , Hospital Costs/trends , Hospital Costs/statistics & numerical dataABSTRACT
Se realizó un estudio descriptivo y transversal, de utilización de medicamentos de tipo prescripción-indicación, de los 303 adultos que recibieron tratamiento antimicrobiano, ingresados en los servicios de Cuidados Intensivos, Medicina Interna y Cirugía del Hospital General Orlando Pantoja Tamayo del municipio de Contramaestre, desde enero hasta junio de 2015, con vistas a evaluar la prescripción de estos medicamentos y su relación con la resistencia bacteriana. En la serie, de un total de 568 prescripciones evaluadas predominaron las inadecuadas (82,3 por ciento); asimismo, los antimicrobianos más prescriptos resultaron ser la cefuroxima y la ceftriaxona, que también presentaron el mayor número de cepas resistentes y el Staphylococcus aureus resultó ser el germen con mayor resistencia
A descriptive and cross-sectional study on the use of prescription-indication medications of the 303 adults that received antimicrobian treatment was carried out. They were admitted to the Intensive Care, Internal Medicine and Surgery services of Orlando Pantoja Tamayo General Hospital in Contramaestre, from January to June, 2015, aimed at evaluating the prescription of these medications and their relationship with the bacterial resistance. In the series, there was a prevalence of inadequate prescriptions (82.3 percent) from a total of 568 that were evaluated; also, the most prescribed antimicrobians were the cefuroxime and the ceftriaxone that also presented the highest number of resistant stumps and the Staphylococcus aureus was the germ with higher resistance
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Drug Prescriptions , Drug Resistance, Microbial , Cross Infection/therapy , Anti-Infective Agents/pharmacokinetics , Epidemiology, Descriptive , Cross-Sectional Studies , Intensive Care Units , Internal MedicineSubject(s)
Adult , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/etiology , Community-Acquired Infections/pathology , Community-Acquired Infections/diagnostic imaging , Community-Acquired Infections/therapy , Cross Infection/diagnosis , Cross Infection/drug therapy , Cross Infection/etiology , Cross Infection/diagnostic imaging , Cross Infection/therapy , Guideline Adherence , Humans , Pneumonia/diagnosis , Pneumonia/drug therapy , Pneumonia/etiology , Pneumonia/pathology , Pneumonia/diagnostic imaging , Pneumonia/therapyABSTRACT
A rinossinusite é uma das principais causas de febre em pacientes críticos e deve ser sistematicamente pesquisada. OBJETIVO: Avaliar o impacto da punção do seio maxilar à beira leito, no diagnóstico e no tratamento dos pacientes com rinossinusite infecciosa internados em Unidade de Terapia Intensiva de um hospital universitário de alta complexidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que avaliou os pacientes em ventilação mecânica com febre de origem indeterminada e sinais tomográficos de rinossinusite submetidos à punção do seio maxilar pelo meato inferior. RESULTADOS: A amostra total do estudo consistiu de 27 pacientes (70,3% do sexo masculino com média de idade 45,3 anos). Os diagnósticos de admissão mais frequentes na Unidade de Terapia Intensiva foram Trauma Crânio Encefálico e Acidente Vascular Cerebral. No exame tomográfico, os seios paranasais mais acometidos foram o maxilar, em 85,2%, e esfenoidal, em 74,1%. A secreção purulenta foi visualizada no meato médio em 30,7% das fossas nasais. Os microrganismos mais frequentes nos aspirados dos seios foram Pseudomonas aeruginosa e Acinetobacter baumannii. CONCLUSÃO: A punção do seio maxilar à beira leito demonstrou-se uma importante ferramenta diagnóstica e terapêutica nos pacientes de UTI com rinossinusite hospitalar, submetidos à ventilação mecânica invasiva.
Rhinosinusitis is one of the most commom causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and theraupetic tool for critically ill patients.
Subject(s)
Female , Humans , Male , Middle Aged , Cross Infection/diagnosis , Rhinitis/diagnosis , Sinusitis/diagnosis , Cross Infection/microbiology , Cross Infection/therapy , Intensive Care Units , Punctures , Retrospective Studies , Rhinitis/microbiology , Rhinitis/therapy , Sinusitis/microbiology , Sinusitis/therapyABSTRACT
La infección relacionada con la fractura abierta de tibia constituye una complicación importante ya que tiene relación directa con el pronóstico y el resultado funcional. En nuestro hospital se desconoce su incidencia y si ocurre con mayor frecuencia con el uso de fijador externo. Se realizó estudio observacional tipo cohorte prospectiva en pacientes mayores de 16 años que ingresaron al servicio de ortopedia y traumatología del Hospital de San José con diagnóstico de fractura abierta de tibia en el período abril 2008 a abril 2009. Hubo seguimiento desde su ingreso hospitalario hasta los controles posteriores. Se evaluaron un total de 71 casos en los cuales predominaron el sexo masculino (84,5%) y el accidente de tránsito como mecanismo de trauma (78,8%). La incidencia total de infección en la población a estudio fue de 9,8% y el germen aislado con mayor frecuencia fue Staphylococcus aureus en (57,1%). Todos los infectados fueron manejados con fijación externa provisional y en su mayoría fueron grado IIIA en la clasificación de Gustilo (36,6%), siendo las fracturas II y III en las que se presentó con mayor frecuencia. Concluimos que todos los casos de infección se documentaron con fijación externa y debe ser considerada en el manejo de estos pacientes.
Infection associated to open tibia fractures is considered an important complication for it is directly related to prognosis and functional results. Its incidence is unknown in our hospital and is mainly associated with the use of an external fixator. An observational prospective cohort study was conducted in patients older than 16 years of age admitted to the orthopedics and traumatology service at the Hospital de San José with a diagnosis of open tibia fracture, between April 2008 and April 2009. Follow-up was carried out from admission to control visits. A total number of 71 cases were assessed with male predominance (84,5%) and car accident as trauma mechanism (78,8%). Total incidence of infection in the study population was 9,8% and the most frequently identified organism was Staphillococcus aureus in 57,1%. All affected patients had been managed with a provisional external fixation and most of them were categorized grade IIIA on the Gustillo classification (36,6%). The majority were grade II and III fractures. We conclude that all cases of infection were associated to external fixation, thus, it must be considered in the management of these patients.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Tibial Fractures , Fractures, Open/complications , Fracture Fixation , Staphylococcal Infections/therapy , Cross Infection/therapy , Wound Infection/therapyABSTRACT
Objective. To determine the risk factors for development of bronchopulmonary dysplasia (BPD) by evaluating mild and moderate/severe BPD in extramural neonates with a birth weight <1501 g. Methods. A case-control study was conducted between January 1, 2004- December 31, 2006. Patients with BPD and without BPD were compared. Bronchopulmonary dysplasia was diagnosed and classified according to the Bancalari criteria. One-hundred and six (106) extramural premature infants with a birth weight <1501 g and admitted to the Neonatal Unit in the first three days of life and survived for more than 28 postnatal days were included. Patients with multiple congenital anomalies and complex cardiac pathologies were excluded. The maternal and neonatal risk factors, clinical features, mechanical ventilation treatment were compared. The principal risk factors for BPD development were analyzed and followed by logistic regression test. Results. The diagnosis was mild BPD in 27 of the 106 patients and moderate/severe BPD in 29. The incidence of BPD was 52.8%. Fifty of 106 patients had no BPD. Analysis of risk factors revealed that gestational age ≤28 weeks (p=0.019), birth weight ≤1000 g (p=0.007), hypothermia (p=0.003), acidosis (p=0.003) and hypotension (p=0.005) at admission, respiratory distress syndrome (RDS) ( p<0.001), mechanical ventilation therapy (p<0.001), surfactant therapy (p=0.005), higher amount of mean fluid therapy on 7th days (p=0.008), nosocomial infection (p<0.001), higher amount of mean packed red cell transfusions (p<0.001) and more than two packed red cell transfusions (p=0.033) were risk factors associated with the development of BPD. Multivariant logistic regression analysis showed acidosis at admission (OR 5.12, 95%CI 1.17–22.27, p=0.029), surfactant treatment (OR 7.53, 95%CI 2.14–26.45, p=0.002), nosocomial infections (OR 4.66, 95%CI 1.27–17.12, p=0.02) and PDA (OR 9.60, 95%CI 2.23–41.22, p=0.002) were risk factors increasing the severity of BPD. Conclusion. The most important risk factors for BPD development in our study were RDS and nosocomial infections while the presence of acidosis at admission, surfactant administration, nosocomial infections and the presence of PDA were the most important risk factors regarding BPD severity. Presence of acidosis at admission as a risk factor emphasized the importance of suitable transport conditions for premature infants.
Subject(s)
Acidosis, Respiratory/diagnosis , Acidosis, Respiratory/mortality , Acidosis, Respiratory/therapy , Analysis of Variance , Bronchopulmonary Dysplasia/diagnosis , Bronchopulmonary Dysplasia/etiology , Bronchopulmonary Dysplasia/mortality , Bronchopulmonary Dysplasia/therapy , Case-Control Studies , Chi-Square Distribution , Combined Modality Therapy , Cross Infection/diagnosis , Cross Infection/mortality , Cross Infection/therapy , Female , Follow-Up Studies , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Logistic Models , Male , Probability , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/mortality , Respiratory Distress Syndrome, Newborn/therapy , Risk Assessment , Severity of Illness Index , Survival Analysis , TurkeyABSTRACT
Las infecciones intrahospitalarias, se presentan después de las primeras 48 a 72 horas de estadía en el hospital y son aquellas que no estaban presentes o se encontraban en periodo de incubación al momento del ingreso, o se manifiesta hasta las 72 horas después del alta, repercutiendo en la recuperación del paciente. El presente trabajo tiene la finalidad de establecer la relación entre infección nosocomial asociada a procedimientos invasivos y el tiempo de permanencia de los mismos, durante la estadía del paciente en el servicio de Terapia Intensiva, del Hospital Clínico Viedma en la gestión 2007.El presente estudio es de carácter descriptivo y de orden transversal, cuenta con una población total de 81 pacientes internados durante la gestión 2007. Se constató que las principales causas de infecciones nosocomiales son las que comprometen a los sistemas relacionados con el uso de procedimientos invasivos, entre ellos, las infecciones respiratorias, urinarias, endovasculares y heridas quirúrgicas.El tiempo de permanencia de las medidas invasivas es uno de los factores determinantes, pues se observó que a mayor tiempo de permanencia existe mayor crecimiento de microorganismos, identificándose entre ellos: El Staphylococcus aureus, el Acinetobacter, la Aspergilosis, la Klebsiella pneumoniae, el Citrobacter, la Candida albicans, el Enterococo fecales y la Escherichia coli, en frecuencias variables, identificados en procedimientos endovasculares, de intubación endotraqueal, en pacientes con cateterismo vesical e infección de herida quirúrgica, diagnosticadas por laboratorio. Palabras claves: Infección, infecciones intrahospitalarias, agentes infecciosos, microorganismos, inmunidad, procedimientos invasivos, patógeno, germen, aislamiento, unidad de cuidados intensivos, bioseguridad
Subject(s)
Bolivia , Cross Infection/surgery , Cross Infection/therapyABSTRACT
Influenza es una enfermedad respiratoria aguda estacional, responsable de brotes periódicos intrahospitalarios. Los mecanismos de transmisión son a través de gotitas y contacto directo o indirecto con secreciones respiratorias, siendo la transmisión por aerosoles de menor magnitud. Los pacientes más afectados son los sujetos inmunosuprimidos, quienes pueden complicarse con neumonía, la cual se asocia con una mortalidad elevada. Las principales medidas de prevención son la vacunación del personal de salud y disminuir la exposición de los contactos con pacientes de alto riesgo. El uso de antivirales anti-influenza permite el bloqueo de brotes si es usado en forma precoz, al igual que el tratamiento del caso índice.
Subject(s)
Humans , Influenza, Human/complications , Influenza, Human/prevention & control , Influenza, Human/transmission , Cross Infection/prevention & control , Cross Infection/virology , Antiviral Agents/therapeutic use , Disease Outbreaks/prevention & control , Influenza, Human/epidemiology , Influenza, Human/therapy , Immunocompromised Host , Cross Infection/therapy , Risk Factors , Influenza Vaccines/administration & dosageABSTRACT
Las infecciones nosocomiales constituyen un problema de salud pública, debido a las altas tasas de morbimortalidad que ocasiona y por los altos costos económicos que generan. Las unidades de cuidados intensivos son una de las principales áreas donde se registra una alta incidencia de infección nosocomial, siendo la sepsis la principal infección en la cual se involucran una gran variedad de microorganismos. El grupo de Staphylococcus coagulasa negativa (SCN), es uno de los agentes etiológicos más frecuentemente aislados. De ahí nuestro interés en realizar la caracterización de 32 cepas de SCN aisladas de neonatos con infección nosocomial en la Unidad de Alto Riesgo Neonatal (UARN) del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela; durante el período diciembre 1997-Abril 1999. Los resultados muestran que el aislamiento de SCN fue de 47,37 por ciento. El 78,1 por ciento de las cepas estudiadas se aislaron de neonatos con bacteremia. Las especies más frecuentes fueron S. epidermidis (46,9 por ciento) y S. warneri (34,4 por ciento). Todas las cepas evaluadas mostraron resistencia a la penicilina y en un 18,8 por ciento de ellas mediada por la producción de B-lactamasa. El 68,8 por ciento de las cepas fueron resistentes a oxacilina y el 78,1 por ciento a gentamicina. La mayoría de las cepas resistentes a oxacilina mostraron valores de CIM g/mL, y se detectó la presencia de la PBP2a. Ninguna de las cepas fueron hiperproductoras de B-lactamasa. Se observó una excelente actividad de la vancomicina y quinupristin-dalfopristin sobre todas las cepas SCN evaluadas. Debido al papel que tienen los SCN en la UARN del IAHULA, es necesario extremar las medidas de asepsia durante los procedimientos de diagnóstico y terapéuticos invasivos, con el propósito de evitar las infecciones causadas por este grupo de microorganismos.
Nosocomial infections constitute a public health problem due to a high level of morbidity and mortality, generating high health-care costs in hospitals. Intensive care units are the principal areas where a high incidence of nosocomial infections is reported. Bacterimia is the principal infection involving a large variety of microorganisms; coagulase-negative Staphylococcus (CNS) is one of the most frequently isolated pathogens. Therefore, the purpose of this study was to characterize the 32 strains of CNS isolated from neonates with nosocomial infections in the High Risk Neonatal Unit (HRNU) at the University of the Andes Hospital Autonomous Institute (UAHAI), Mérida, Venezuela, from December 1997 to April 1999. Results showed that the isolation of CNS was 47.37 percent; 78.1 percent of the species were isolated from neonates with bacteremia. S. epidermidis (46.9 percent), and S. warneri (34.4 percent) were the species most frequently found. All pathogens showed resistance to penicillin and 18.8 percent of them produced ß-lactamase; 68.8 percent were resistant to oxacillin and 78.1 percent to gentamicin. Most of the oxacillin-resistant strains showed MIC values above 0.5 mg/mL and the presence of PBP2a was detected. None of the strains were hyper-producers of ß-lactamase. Vancomicin and quinuprintin/dalfopristin showed excellent activity against these CNS. Due to the role of CNS as a pathogen in the HRNU of UAHAI, strong asepsis measures during diagnosis and therapeutic invasive procedures must be taken to prevent infections caused by this group of microorganisms.
Subject(s)
Humans , Male , Female , Infant, Newborn , Critical Care/methods , Cross Infection/diagnosis , Cross Infection/therapy , Methicillin Resistance , Phenotype , Staphylococcus/chemistry , MicrobiologyABSTRACT
La infección asociada a catéter venoso central no ha sido una limitación para la adopción universal de su uso en cuidado intensivo. Por otra parte, esto sí ha llevado a la búsqueda de mejores aproximaciones en la prevención, diagnóstico y tratamiento de esta infección, lo cual motivó en Chile la realización de un Consenso Nacional de Infecciones Asociadas a Catéter Venoso Central en el año 2003. Sin embargo, la información acumulada en los últimos años nos obliga a reafirmar o corregir los aspectos evaluados, en este artículo se revisa los tópicos más importantes en relación a catéter venoso central enfatizando aquéllos en que existe nueva información.
The central venous catheter infection has not been an obstacle to the general utilization of these devices in intensive care units. On the other hand, new strategies in prevention, diagnosis and treatment of this type of infection have been developed. In 2003, a National Consensus of Venous Catheter Infection was published; nonetheless, new information reported in last years has confirmed or corrected some concepts pointed out at that time. This review focuses on the most important topics in the subject, emphasizing those in which new knowledge has been added.
Subject(s)
Humans , Male , Female , Child , Adult , Catheterization, Central Venous/adverse effects , Cross Infection/etiology , Cross Infection/diagnosis , Cross Infection/therapyABSTRACT
A infecção continua sendo a maior causa de morbidade e de mortalidade em pacientes traumatizados ou submetidos a cirurgia de emergência, apesar dos esforços na prevenção e nos avanços na terapia antimicrobiana. A infecção pode surgir no local do trauma ou na via de acesso para o tratamento cirúrgico, mas a mais importante é a infecção hospitalar, que ocorre em geral fora do sítio cirúrgico ou do local de trauma, como as pneumonias, infecções do trato urinário e relacionadas às punções vasculares. São determinantes da infecção o número e a virulência da bactéria e por outro lado a resistência do hospedeiro. Também são fatores predisponentes o choque, a hipoxemia, as transfusões sanguíneas, a hipotermia, a má nutrição, o alcoolismo crônico e o diabete, dentre outras. Para evitar a infecção devem ser adotadas práticas adequadas de controle da infecção tanto local quanto sistêmico.
Infection remains the major cause of morbidity and mortality in trauma patients and in patients submitted to emergency operations, despite preventive strategies and potent antibiotics. The infection can appear as wound infection at the site of injury or at the route employed for its repair. The most important kind of infection is the nosocomial one, referring to those that occur remote from the site of injury or operation as pneumonia, urinary tract infection, and related to the intravascular catheter. The number of bacteria, its virulence and poor host defense are determinants of infection. Shock, hypoxemia, blood transfusion, systemic hypothermia, malnutrition, chronic alcoholism, diabetes are factors that predispose to infection. To avoid this condition, prevention begins with appropriate local and systemic practices of infection control.
Subject(s)
Humans , Catheterization , Wounds and Injuries , Cross Infection/prevention & control , Cross Infection/therapy , Surgical Wound Infection/prevention & controlABSTRACT
OBJETIVO: Avaliar o impacto da implantação de um guia terapêutico para o tratamento empírico de pneumonia hospitalar. MÉTODOS: Foi realizado um ensaio clínico com controle histórico, no período de junho de 2002 a junho de 2003, em pacientes internados na unidade de terapia intensiva (UTI) que adquiriram pneumonia hospitalar. Todos foram tratados de acordo com um guia terapêutico desenvolvido pela Comissão de Controle de Infecção Hospitalar da instituição (grupo com intervenção). Para o controle, foram analisados os prontuários dos pacientes que adquiriram pneumonia hospitalar no período de junho de 2000 a junho de 2001 (grupo sem intervenção). Foram determinados taxa de mortalidade, tempo médio de tratamento e tempo de internação na UTI e no hospital dos pacientes que adquiriram pneumonia hospitalar. RESULTADOS: A mortalidade relacionada à pneumonia foi menor no grupo tratado de acordo com o guia terapêutico (26 x 53,6 por cento; p = 0,00). Quanto à mortalidade geral, não houve diferença estatisticamente significativa entre os dois períodos (51 x 57,9 por cento; p = 0,37). Também não foi encontrada diferença quanto aos tipos de microorganismos isolados, tempo de tratamento e tempo de internação na UTI e no hospital. CONCLUSÃO: A implantação do guia terapêutico para tratamento de pneumonia hospitalar adquirida em UTI pode ser eficaz na diminuição das taxas de mortalidade.
OBJECTIVE: To evaluate the impact that the implementation of therapeutic guidelines has on the empirical treatment of nosocomial pneumonia. METHODS: A clinical trial, using historical controls and involving current ICU patients who had acquired nosocomial pneumonia, was carried out from June of 2002 to June of 2003. All were treated according to therapeutic guidelines developed by the Commission for Nosocomial Infection Control of the institution (group with intervention). As controls, the medical charts of the patients who acquired nosocomial pneumonia between June of 2000 and June of 2001 (group without intervention) were analyzed. Mortality and mean treatment period, as well as the length of hospital and ICU stays, were determined for the patients who acquired nosocomial pneumonia. RESULTS: Mortality associated with pneumonia was lower in the group treated according to the therapeutic guidelines (26 vs. 53.6 percent; p = 0.00). As for overall mortality, there was no statistically significant difference between the two periods (51 vs. 57.9 percent; p = 0.37). There was also no difference in the type of microorganisms isolated, treatment period, length of hospital stay or length of ICU stay. CONCLUSION: The implementation of therapeutic guidelines for the treatment of nosocomial pneumonia acquired in the ICU can be efficacious in decreasing mortality rates.
Subject(s)
Female , Humans , Male , Middle Aged , Cross Infection/therapy , Pneumonia, Bacterial/mortality , Pneumonia, Bacterial/therapy , Practice Guidelines as Topic/standards , Anti-Bacterial Agents/therapeutic use , Brazil/epidemiology , Comorbidity , Cross Infection/drug therapy , Epidemiologic Methods , Hospitals, University , Intensive Care Units , Length of Stay , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Survival Analysis , Time FactorsABSTRACT
OBJETIVO: Avaliar a incidência de bacteremias, seu perfil de suscetibilidade antimicrobiana, e fatores associados ao óbito, em hospital universitário, no período de 1° de janeiro de 2000 a 31 de dezembro de 2001. MÉTODOS: Coorte retrospectiva. Pacientes maiores de 1 ano de idade, com bacteremia laboratorialmente confirmada e clinicamente significativa foram incluídos no estudo. Realizada análise de sobrevida multivariada, seguindo o modelo de riscos proporcionais de Cox. RESULTADOS: Foram detectados 295 episódios de bacteremia. O patógeno mais freqüente foi o Staphylococcus aureus: 118 (40 por cento), com 55,9 por cento de MRSA. A letalidade pela bacteremia foi de 34,5 por cento. Os fatores de risco independentes para o óbito foram terapia inicial inadequada (HR ajustado 2,05 IC 95 por cento: 1,25-3,36) e gravidade da apresentação clínica (HR ajustado 5,52 IC 95 por cento: 3,15-9,69). CONCLUSÃO: Nosso estudo mostrou elevada letalidade associada a bacteremia, com alta freqüência de MRSA. A terapia inicial inadequada e a gravidade da apresentação clínica foram fatores de risco independentes para o óbito pela bacteremia.
OBJECTIVE: To evaluate the frequency and profile of bacteremia, its antimicrobial susceptibility and to analyze predictors of mortality in bloodstream infections (BSI) at this Teaching Hospital from January 1, 2000 to December 31, 2001. METHODS: Design: retrospective cohort. Patients over one year old with clinically significant episodes of BSI which were microbiologically documented were included in the study. The Cox proportional hazards risk model was applied to identify prognostic factors related to death by bacteremia. RESULTS: A total of 295 episodes of BSI were detected. The most common pathogen was S. aureus: 118 (40.0 percent), with 55.9 percent of MRSA. Mortality associated with bacteremia was 34.5 percent. Independent predictors of mortality were: inadequate initial therapy (HR adjusted 2.05 IC95 percent: 1.25-3.36) and severity of the clinical manifestations (HR adjusted 5.52 IC95 percent: 3.15-9.69). CONCLUSION: This study disclosed high mortality rates due to BSI and a high frequency of MRSA. Inadequate initial therapy and severity of clinical manifestations were significantly and independently associated with mortality.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Bacteremia , Cross Infection , Bacteremia/microbiology , Bacteremia/mortality , Bacteremia/therapy , Brazil/epidemiology , Cross Infection/microbiology , Cross Infection/mortality , Cross Infection/therapy , Epidemiologic Methods , Hospitals, Teaching , Length of Stay/statistics & numerical data , Methicillin Resistance , Prognosis , Time Factors , Treatment FailureABSTRACT
Staphylococcus aurues is on important cause of community and hospital- aquired infections. Caused by methicillin or oxacillin- resistant s.aureus [MRSA] are mainly nosocomial and are increasingly from many countries word wide. Many attempt have been made by the reasearchers to find new compounds as a subsitute for this antibiotics. The aim of this study was to investigate the antimicrobial activity of alcoholic extracts of 20 medical plants species of Golestan provience on clinical and standard strains of MRSA and MSSA and comprative and detect the best medical plant. In this study the compounds of the plant were extracted by percolation method and the effect of ethanolic extract of 20 Iranian medical plants against methicillin resistant and methicillin sensitve strains were assessed by disc diffusion method and each test were repeated 3 times and mean inhibition zone were recorded and then, the minimum inhibitory concentration [MIC] of the extracts, that show good inhibition zone in disc diffusion method, was determined by the micro broth dilution method. The results of antibacterial activity of the ethanolic extracts of 20 plants revealed that, the ethamlic extracts of 8 plants have the best effect on strains and the maximum mean inhibition zone was 22.4 mm and the lowest MIC of plants was 0.01 mg/ml. The result of this study indicate that, ethanolic extract of Eucalyptus. Global, Peganum.hermla, Punica.granatum, Berberis.vulgaris, Ttamarixaphylla, Nnigella.sativa, Hypericum.perforatum AND, Artemisia. Herbaalba have the best antibacterial effect against MRSA andMSSA. The result obtained from these plants might be considered sufficent for further study
Subject(s)
Plants, Medicinal , Methicillin-Resistant Staphylococcus aureus , Cross Infection/therapy , Staphylococcus aureus , Eucalyptus , Peganum , 37052 , Plant Extracts , Berberis , Hypericum , ArtemisiaABSTRACT
Neste ensaio a autora descreve a evolução histórica das infecções e seus tratamentos de modo a traçar uma interface destas com o panorama moderno da epidemiologia e controle das infecções hospitalares. Analisam-se tratamentos desenvolvidos a partir da idade média, incluindo-se desde mitos e crenças populares a dados que tem sido objeto de avaliação científica microbiológica e terapêutica. Este estudo ressalta o fato de que o reflorescimento das ciências ocorrido no Renascimento, juntamente com o surgimento da imprensa e, com ela, a veiculação de publicações e ilustrações sobre as doenças, contribuíram para a evolução da própria ciência e sua tecnologia.
The author describes the historical evolution of infection and its treatment so as to trace an interface of these issues and the modern panorama of epidemiology and control of hospital infection. This study reviews data on treatments that have been used since the Middle Ages, including from myths and popular beliefs to data that has been the object of scientific microbiological and therapeutic evaluation. The study takes into consideration the fact that the rebirth of science during the Renaissance, along with appearance of the press, which made the publication of news and pictures on illness possible, contributed to the evolution of science and its technology.
En este ensayo la autora describe la evolución histórica de las infecciones e sus tratamientos de manera a trazar una interfaz de estas con el panorama moderno de la epidemiología e control de las infecciones hospitalarias. se analizan tratamientos desarrollados a partir de la edad media, incluyéndose desde mitos e creencias populares a datos que tienen sidos objeto de evaluación científica, microbiológica y terapéutica.Este estudio resalta el hecho de que el reflorecimiento de las ciencias ocurrido en el Renacimiento, juntamente com el surgimiento de la imprenta, y, com ella la veiculación de publicaciones e ilustraciones sobre enfermedades, contribuyeron para la evolución de la propia ciencia y su tecnologia.
Subject(s)
History, 19th Century , History, 20th Century , History, Medieval , Humans , Cross Infection/history , Cross Infection/therapySubject(s)
Humans , Infant, Newborn , Disease Outbreaks/prevention & control , Infection Control/methods , Infection Control/standards , Intensive Care Units, Neonatal , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/mortality , Cross Infection/prevention & control , Cross Infection/therapy , Cross Infection/transmission , Anti-Bacterial Agents/therapeutic use , Clinical Laboratory Techniques , Drug Therapy, Combination , Enterocolitis, Necrotizing/etiology , Enterocolitis, Necrotizing/microbiology , Enterocolitis, Necrotizing/drug therapy , Follow-Up Studies , Infectious Disease Medicine , Antibiotic Prophylaxis , SepsisABSTRACT
Debido a características naturales de la cognición humana, actos inseguros se cometen durante las tareas habituales. El impacto y consecuencias de los errores humanos en sistemas complejos han sido ampliamente documentados y estudiados, y distintas técnicas y metodologías de análisis fueron desarrolladas. No hemos hallado casos publicados de secuencias accidentales analizadas mediante tales técnicas en la literatura médica en castellano, por lo que nos pareció novedoso hacerlo. Se realizó el análisis retrospectivo del evento indeseado "infección accidental de paciente neutropénico con germen intrahospitalario" utilizando en forma combinada técnicas de análisis de causa raíz, análisis de acciones humanas y análisis de secuencias accidentales. Se identificaron claramente factores causales de errores activos del personal, fallas en el diseño del sistema y deficiencias en la cultura de seguridad de la organización y sus individuos. Finalmente proponemos un glosario en español, por primera vez, con los contenidos necesarios para sentar bases de esta nueva modalidad dentro de la medicina. En conclusión, los resultados obtenidos proveen importantes datos acerca de la seguridad. La aplicación de estos métodos en forma sistemática podría significar una herramienta eficaz para mejorar la seguridad de los procesos transfusionales.
Subject(s)
Humans , Male , Child , Medical Errors/statistics & numerical data , Medical Errors/prevention & control , Security Measures , Blood Transfusion/standards , Equipment Contamination , /methods , Cross Infection/therapy , Methicillin Resistance , Neutropenia , Quality of Health Care , Staphylococcus aureus , Blood Component Transfusion/adverse effectsABSTRACT
Avaliou-se a influência dos parâmetros farmacocinéticos da vancomicina sobre a variação da sua concentração plasmática no vale em dois grupos de recém-nascidos pré-termo estatisticamente diferentes quanto à idade pós-conceptual (grupo 1: 32 semanas; grupo 2: 34 semanas) e pós-natal (grupo 1: 15.3 dias; grupo 2: 26 dias). A meia-vida e o volume aparente de distribuição, respectivamente, não apresentaram correlação (p 0,05) com a concentração plasmática de vancomicina no grupo 1 e no grupo 2. Através de regressão linear múltipla, no grupo 1, percebeu-se maior influência do volume aparente de distribuição e também da meia-vida (r = 0,85). No grupo 2, predominou o clearance total de vancomicina (r= 0,90). Concluiu-se que essa influência varia de acordo com a idade pós-conceptual e pós-natal dos recém-nascidos pré-termo/The influence of vancomycin pharmacokinetic parameters on the variation of its trough concentration was evaluated in two groups of preterm infants which were statistically diferent in terms of mean postconceptional age (group 1: 32 weeks; group 2: 34 weeks) and postnatal age (group 1: 15.3 days; group 2: 26 days). The half-life and apparent volume of distribution, respectively, did not present correlation (p 0.05) with the vancomycin serum concentration in group 1 and in group 2. Using multiple linear regression, a stronger influence of the apparent volume of distribution and also of the half-life (r= 0.85) was found in group 1. There was predominant influence of the vancomycin body clearance (r= 0.90) in group 2. In conclusion, that influence varies in accordance with the postconceptional and postnatal ages of preterm infants...