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1.
Rev. Soc. Bras. Med. Trop ; 44(4): 447-450, July-Aug. 2011. tab
Article in English | LILACS (Americas) | ID: lil-596616

ABSTRACT

INTRODUCTION: The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). METHODS: Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. RESULTS: 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. CONCLUSIONS: In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.


INTRODUÇÃO: O objetivo deste estudo foi estabelecer a taxa de sepse de ataque tardio (LOS) do nosso serviço, caracterizar a microbiota intestinal e avaliar uma possível associação entre a flora intestinal e sepse em recém-nascidos cirúrgicos que estavam recebendo nutrição parenteral (NP). MÉTODOS: Culturas do intestino foram colhidas no início da nutrição parenteral e, posteriormente, uma vez por semana. As amostras para a cultura de sangue foram coletadas com base em critérios clínicos estabelecidos pela equipe médica. A ponta do cateter venoso central (CVC) foi removida sob condições assépticas. Métodos laboratoriais padrão foram usados para identificar os microrganismos que cresceram em culturas de sangue, do intestino, e da ponta do CVC. RESULTADOS: Foram analisados 74 recém-nascidos de muito baixo peso. Todas as crianças estavam recebendo nutrição parenteral e antibióticos quando a cultura do intestino foi iniciada. No total, 21 (28,4%) crianças apresentaram 28 episódios de sepse tardia sem fonte identificada. Os estafilococos coagulase negativo foram os mais comuns das bactérias identificadas, tanto no intestino (74,2%) como no sangue (67,8%). Todas as infecções ocorreram em pacientes que receberam nutrição parenteral através de um cateter venoso central. Seis crianças experimentaram episódios de translocação microbiana. CONCLUSÕES: Neste estudo LOS foi o episódio mais frequente em recém-nascidos recebendo nutrição parenteral e submetidos a cirurgia, 28,6% da infecção provavelmente foi um fenômeno derivado do intestino o que exige novas estratégias para a prevenção.


Subject(s)
Humans , Infant , Infant, Newborn , Catheters, Indwelling/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Infant, Very Low Birth Weight , Intestines/microbiology , Parenteral Nutrition/adverse effects , Sepsis/etiology , Bacterial Translocation , Catheterization, Central Venous/adverse effects , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , Time Factors
2.
J. bras. nefrol ; 33(1): 86-92, jan.-mar. 2011. ilus, tab
Article in Portuguese | LILACS (Americas) | ID: lil-579709

ABSTRACT

INTRODUÇÃO: A elevada incidência de pacientes iniciando ou sendo mantidos em tratamento dialítico através de cateteres venosos tem aumentado o número de infecções da corrente sanguínea relacionadas aos cateteres e suas consequências, obrigando a busca de substâncias que tenham propriedades anticoagulantes e que também impeçam a contaminação dos mesmos. OBJETIVOS: Comparar a utilização de heparina e citrato trissódico como selo de cateteres de longa permanência quanto à ocorrência de pirogenia, bacteremia, internações hospitalares relacionadas à infecção, trombose e óbito. MÉTODOS: Estudo retrospectivo por meio de dados do registro de infecção do Programa de Controle e Prevenção de Infecções e Eventos Adversos, onde foram incluídos todos os pacientes que entre abril de 2006 e março de 2008 utilizaram cateteres de longa permanência. Nos primeiros 365 dias, o selo do cateter foi feito com heparina (Grupo Heparina) e nos 365 dias seguintes foi feito com citrato trissódico a 46,7 por cento (Grupo Citrato). Sessenta e cinco pacientes fizeram parte do estudo utilizando noventa e dois cateteres. Os grupos foram comparados para ocorrência de pirogenia, bacteremia, hospitalização, trombose de cateter e óbito. RESULTADOS: A ocorrência de bacteremia relacionada ao cateter e o tempo de hospitalização foram significantemente menores no Grupo Citrato. Houve uma tendência a menor ocorrência de hospitalização relacionada à infecção de acesso no Grupo Citrato (p = 0.055), e não houve diferença quanto à trombose de cateteres levando a disfunção. O tempo livre de bacteremia e de hospitalização foram maiores no Grupo Citrato. A ocorrência de bacteremia esteve associada a ser diabético e a pertencer ao Grupo Heparina. Na análise multivariada, apenas pertencer ao Grupo Heparina esteve associada à sua ocorrência.


INTRODUCTION: The high incidence of patients beginning dialysis treatment with venous catheters, as well as the growing number of patients with permanent catheter access, has increased catheter- related blood infections and their consequences. Thus the search for substances with anticoagulant properties that also prevent catheter contamination is necessary. OBJECTIVE: This study aimed at comparing heparin and trisodium citrate used as long-term catheter locking solutions regarding the occurrence of pyrogenic reaction, bacteremia, infection- related hospitalizations, thrombosis, and death. METHODS: Retrospective study on the infection data from the Infection and Adverse Event Prevention Control Program registry, which included all hemodialysis patients using long-term catheters from April, 2006 to March, 2008. During the first 365 days, catheters were locked with heparin (Heparin group) and, during the following 365 days, with 46.7 percent trisodium citrate (Citrate group). Sixty-five patients were included in the study using 92 catheters. The groups were compared regarding the occurrence of pyrogenic reaction, bacteremia, hospitalization, catheter thrombosis, and death. RESULTS: The catheter-related bacteremia episodes were significantly lower and hospitalization time was significantly shorter in the Citrate group when compared with those in the Heparin group. A tendency towards a lower occurrence of access site infection-related hospitalization was observed in the Citrate group (p = 0.055), and no difference was observed in catheter thrombosis leading to dysfunction between groups. Bacteremia-free and hospitalization-free times were longer in the Citrate group. The occurrence of bacteremia was associated with the presence of diabetes and heparin use. In multivariate analysis, being in the Heparin group was the only factor associated with bacteremia.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anticoagulants/therapeutic use , Anticoagulants/therapeutic use , Catheters, Indwelling/microbiology , Catheters, Indwelling , Catheter-Related Infections/prevention & control , Citrates/therapeutic use , Citrates/metabolism , Renal Dialysis , Heparin/therapeutic use , Renal Dialysis , Catheters , Retrospective Studies
3.
Rev. chil. pediatr ; 81(5): 425-431, oct. 2010. tab
Article in Spanish | LILACS (Americas) | ID: lil-577527

ABSTRACT

Introduction: The use of a permanent Central Venous Catheter (CL) in oncologic patients allows a secure and rapid access. Infection is an important risk. "Lock therapy" (LT) consists of the application of a high concentration of antibiotics in the lumen of the catheter, for the purpose of eradicating bacteria. Objective: To describe the use of LT associated with the systemic use of antibiotics in CL infections occurring among pediatric oncological patients. Methods: A descriptive, retrospective review of charts of children seen at the Oncology Unit, Roberto del Rio Children's Hospital, 2005 to 2007. Evaluated parameters included culture and sensitivity studies, removal of CL and mortality. Results: There were 11 episodes of infection associated to CL in 8 patients, most frequently associated to Staphylococcus coagulase-negative. The CL was preserved in 7 patients. There was no mortality associated to infection. Conclusion: For this group, LT and systemic antibiotics preserved the CL in most patients. Randomized prospective studies are needed in a larger population to support these findings.


Introducción: El uso de catéter venoso central permanente (CVC) en pacientes oncológicos aporta un acceso venoso seguro y expedito. Sin embargo, la infección es una de las principales complicaciones asociadas a su uso. La "lock terapia" es una técnica que consiste en la aplicación en el lumen del catéter de una solución con alta concentración de antibiótico, con el objetivo de erradicar las bacterias presentes en el endolumen. Objetivo: Describir el uso de "lock terapia" asociada a antibióticos sistémicos en infecciones relacionadas a CVC en pacientes pediátricos oncológicos. Métodos: Estudio descriptivo, retrospectivo, donde se analizaron las infecciones asociadas a CVC que fueron tratadas con lock terapia y antibióticos sistémicos en la Unidad de Oncología del Hospital de Niños Roberto del Río entre los años 2005 y 2007. Los parámetros estudiados fueron: cultivo y antibiograma; retiro del CVC y mortalidad. Resultados: Se estudiaron 11 episodios de infección asociada a CVC en 8 pacientes. El microorganismo aislado con mayor frecuencia fue Staphylococcus coagulasa negativo. Se logró conservar el CVC en 7 pacientes. No hubo mortalidad asociada a infección. Conclusiones: En el grupo estudiado, el uso asociado de lock terapia y antibióticos sistémicos permitió conservar el CVC en la mayoría de los casos. Se requieren estudios prospectivos randomizados con un mayor número de pacientes que permitan corroborar estos hallazgos.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Anti-Bacterial Agents/therapeutic use , Catheterization, Central Venous/adverse effects , Equipment Contamination/prevention & control , Disinfection/methods , Neoplasms , Bacteria/isolation & purification , Bacteria , Bacteremia/prevention & control , Catheters, Indwelling/adverse effects , Catheters, Indwelling/microbiology , Catheterization, Central Venous/methods , Cross Infection/epidemiology , Cross Infection/prevention & control , Oncology Service, Hospital , Retrospective Studies , Time Factors
4.
Rev. Inst. Med. Trop. Säo Paulo ; 52(3): 139-143, May-June 2010. tab
Article in English | LILACS (Americas) | ID: lil-550344

ABSTRACT

Phospholipase and proteinase production and the ability of adhesion to buccal epithelial cells (BEC) of 112 Candida isolates originated from oral cavity of HIV infected patients and from blood and catheter of intensive care unit patients were investigated. The proteinase production was detected by inoculation into bovine serum albumin (BSA) agar and the phospholipase activity was performed using egg yolk emulsion. A yeast suspension of each test strain was incubated with buccal epithelial cells and the number of adherence yeast to epithelial cells was counted. A percentage of 88.1 percent and 55.9 percent of Candida albicans and 69.8 percent and 37.7 percent of non-albicans Candida isolates produced proteinase and phospholipase, respectively. Non-albicans Candida isolated from catheter were more proteolytic than C. albicans isolates. Blood isolates were more proteolytic than catheter and oral cavity isolates while oral cavity isolates produced more phospholipase than those from blood and catheter. C. albicans isolates from oral cavity and from catheter were more adherent to BEC than non-albicans Candida isolates, but the adhesion was not different among the three sources analyzed. The results indicated differences in the production of phospholipase and proteinase and in the ability of adhesion to BEC among Candida spp. isolates from different sources. This study suggests that the pathogenicity of Candida can be correlated with the infected site.


A produção de proteinase e fosfolipase e habilidade de adesão à célula epitelial bucal de 112 isolados de Candida originadas da cavidade bucal de pacientes infectados pelo HIV e de sangue e cateter de pacientes hospitalizados foram investigados. A produção de proteinase foi detectada por inoculação em ágar soro albumina bovina e a atividade de fosfolipase foi realizada usando emulsão de gema de ovo. A suspensão de levedura de cada isolado foi incubada com célula epitelial e o número de leveduras aderidas a célula epitelial foi contada. Uma porcentagem de 88,1 e 55,9 por cento de C. albicans e 69,8 e 37,7 por cento de isolados de Candida não albicans produziram proteinase e fosfolipase, respectivamente. Candida não albicans obtidas do cateter foram mais proteolíticos que isolados de Candida albicans (p < 0,001). Isolados do sangue foram mais proteolíticos do que isolados do cateter e cavidade bucal, enquanto isolados da cavidade bucal produziram mais fosfolipase do que aqueles isolados do sangue e cateter. C. albicans isoladas da cavidade bucal e do cateter foram mais aderentes à célula epitelial bucal do que isolados de Candida não albicans, mas não houve diferença na adesão entre os três locais analisados. Os resultados indicaram diferenças na produção de fosfolipase e proteinase e na habilidade de adesão à célula epitelial bucal entre os isolados de Candida das diferentes fontes. Este estudo sugere que a patogenicidade de Candida spp pode estar correlacionada ao local infectado.


Subject(s)
Humans , Aspartic Acid Proteases/biosynthesis , Bacterial Adhesion/physiology , Candida/enzymology , Candida/physiology , Phospholipases/biosynthesis , Candida/isolation & purification , Catheters, Indwelling/microbiology , Epithelial Cells/microbiology , HIV Infections/microbiology , Mouth/microbiology
5.
J. vasc. bras ; 9(1): 46-50, 2010. ilus
Article in Portuguese | LILACS (Americas) | ID: lil-557197

ABSTRACT

Cateteres venosos de longa permanência são amplamente utilizados em pacientes com necessidade de acesso venoso por período prolongado. A infecção relacionada a esses cateteres permanece um desafio na prática clínica. Revisamos a literatura acerca da epidemiologia e tratamento das infecções relacionadas a cateteres. Staphylococcus aureus é a bactéria mais comumente isolada. Os cateteres semi-implantáveis apresentam taxas de infecção maiores que os totalmente implantáveis. O tratamento pode ser feito com locks, antibioticoterapia sistêmica e até mesmo com retirada do cateter, dependendo do tipo de infecção, do microrganismo isolado e das condições clínicas do paciente. O salvamento do cateter deve ser tentado sempre que possível.


Long-term venous catheters are widely used in patients with needs of venous access for prolonged periods. The infection related to these catheters remains a challenge in clinical practice. We reviewed the literature about infection epidemiology and treatment related to catheters. Staphylococcus aureus is the most common isolated bacteria. Tunneled catheters present higher infection rates than implanted ports. Treatment may consist in the use of locks, systemic antibiotics, and even catheter removal, depending on the kind of infection, the isolated microorganism, and the patient's clinical conditions. Catheter salvation should be tried whenever possible.


Subject(s)
Humans , Catheters, Indwelling/microbiology , Renal Dialysis/methods , Staphylococcus aureus/virology , Infections/diagnosis
6.
Medicina (B.Aires) ; 69(6): 655-657, nov.-dic. 2009.
Article in Spanish | LILACS (Americas) | ID: lil-633700

ABSTRACT

Ochrobactrum anthtropi es un bacilo gram negativo aeróbico, no fermentador de la glucosa, anteriormente conocido como Achromobacter sp o CDC grupo Vd. Ha sido aislado del medio ambiente y de infecciones en seres humanos que generalmente presentaban algún tipo de inmunocompromiso. Las infecciones por este microorganismo fueron bacteriemias relacionadas a catéteres y en ocasiones endoftalmitis, infecciones urinarias, meningitis, endocarditis, absceso hepático, osteocondritis, absceso pelviano y absceso pancreático. Se presenta el caso de un paciente de sexo masculino, de 69 años de edad, que consultó a la guardia por hipotensión sostenida y síndrome febril de cuatro días de evolución, escalofrío, sudoración profusa y deterioro del sensorio. El paciente tenía diabetes de tipo 2 y antecedente de accidente cerebrovascular. Debido a insuficiencia renal crónica presentaba un catéter de doble lumen para la diálisis. Se documentó una bacteriemia relacionada a catéter por cultivo de sangre a través de catéter y de vena periférica, utilizando el sistema automatizado de hemocultivos Bact-Alert y la metodología de tiempo diferencial (>120min). La confirmación se realizó, una vez removido el catéter, por la técnica semicuantitativa de Maki (> 15 UFC). El microorganismo fue identificado por API 20NE y Vitek 1 como Ochrobactrum anthropi.


Ochrobactrum anthropi is a non-glucose fermentative, aerobic gram-negative bacillus, formerly known as Achromobacter sp or CDC group Vd. It has been isolated from the environment and from infections in usually immunocompromised human beings. The documented infections frequently involved catheter related bacteremia whereas endophthalmitis, urinary infections, meningitis, endocarditis, hepatic abscess, osteochondritis, pelvic abscess and pancreatic abscess were rarely involved. Here it is presented the case of a male patient aged 69 years with sustained hypotension, four day febrile syndrome, chill, lavish perspiration and sensorium deterioration. He had type 2 diabetes and antecedent of cerebrovascular accident. A double-lumen dialysis catheter was present due to chronic renal insufficiency. An episode of catheter-related bloodstream infection was documented by using Bact-Alert Blood Culture System and Differential-Time-to-Positivity Method for central venous catheter versus peripheral blood cultures (>120 min). Once removed, it was confirmed through Maki semi quantitative technique (>15 FCU). The microorganism was identified by API 20NE and Vitek 1 as Ochrobactrum anthropi.


Subject(s)
Aged , Humans , Male , Bacteremia/microbiology , Catheter-Related Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Ochrobactrum anthropi/isolation & purification , Catheter-Related Infections/diagnosis , Catheters, Indwelling/microbiology
7.
Mem. Inst. Oswaldo Cruz ; 104(6): 905-913, Sept. 2009. tab
Article in English | LILACS (Americas) | ID: lil-529562

ABSTRACT

During a five-year period, 932 clinical isolates from cancer patients treated in a Brazilian reference centre were identified as corynebacteria; 86 percent of the cultures came from patients who had been clinically and microbiologically classified as infected and 77.1 percent of these patients had been hospitalised (71.1 percent from surgical wards). The adult solid tumour was the most common underlying malignant disease (66.7 percent). The univariate and multivariate analyses showed that hospitalised patients had a six-fold greater risk (OR = 5.5, 95 percent CI = 1.15-26.30 p = 0.033) related to 30-day mortality. The predominant species were Corynebacterium amycolatum (44.7 percent), Corynebacterium minutissimum (18.3 percent) and Corynebacterium pseudodiphtheriticum (8.5 percent). The upper urinary tracts, surgical wounds, lower respiratory tracts, ulcerated tumours and indwelling venous catheters were the most frequent sources of C. amycolatum strains. Corynebacterium jeikeium infection occurred primarily in neutropenic patients who have used venous catheters, while infection caused by C. amycolatum and other species emerged mainly in patients with solid tumours.


Subject(s)
Adult , Aged , Female , Humans , Male , Catheter-Related Infections/microbiology , Corynebacterium Infections/microbiology , Corynebacterium/isolation & purification , Cross Infection/microbiology , Neoplasms/microbiology , Analysis of Variance , Catheters, Indwelling/microbiology , Corynebacterium/classification , Retrospective Studies , Risk Factors
8.
Pakistan Journal of Pathology. 2009; 20 (1): 1-2
in English | IMEMR (Eastern Mediterranean) | ID: emr-119596

ABSTRACT

To establish the bacteriological profile of catheter related infections in patients having various indwelling medical devices. Descriptive study. The study was conducted in the Children Hospital and Institute of Child Health, Lahore during November 2005 to March 2006. A total of 100 culture positive samples from these patients were included comprising of 68 samples of Endotracheal Tubes, 14 samples of Peritoneal Dialysis Catheters, 11 samples of Urinary Catheters and 7 samples of Central Venous Catheters. The most frequent catheter colonizing bacteria were Pseudomonas spp. [34.7%], Klebsiella spp. [27.8%]. Escherichia coli [23.5%], Staphylococcus aureus [5.2%], Coagulase negative Staphylococci [3.5%], Proteus spp. [3.5%], Streptococcus pyogenes [0.9%] and non-haemolytic Streptococci [0.9%]. Catheter related infection remains an ongoing problem which cannot be completely eradicated; however by basic rules of hygiene it can be minimized


Subject(s)
Humans , Catheter-Related Infections/etiology , Catheters, Indwelling/microbiology , Catheters, Indwelling/adverse effects , Child , Bacteria , Urinary Catheterization , Catheterization, Central Venous , Intubation, Intratracheal , Peritoneal Dialysis
9.
Rev. panam. salud pública ; 24(3): 195-202, sept. 2008. tab
Article in English | LILACS (Americas) | ID: lil-495418

ABSTRACT

OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS). RESULTS: Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8 percent or 29.8 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7 percent of cases, resistant to ceftazidime in 79.3 percent of cases, and resistant to piperacillin-tazobactam in 85.7 percent of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3 percent of cases, resistant to ceftazidime in 75.5 percent of cases, and resistant to imipenem in 27.7 percent of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3 percent (RR 1.79, P = 0.0149) for VAP, 27.8 percent (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7 percent (RR 1.56, P = 0.2875) for CAUTI. CONCLUSION: The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an ...


OBJETIVOS: Determinar las tasas de infección asociadas a aparatos (IAA), los perfiles microbiológicos, la resistencia bacteriana, la estancia hospitalaria adicional y la mortalidad atribuible en las unidades de cuidados intensivos (UCI) de tres hospitales brasileños miembros de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales (INICC). MÉTODOS: Se realizó una vigilancia prospectiva de cohorte de las IAA en cinco UCI de tres hospitales urbanos de Brasil, según las definiciones del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) de los Estados Unidos de América. RESULTADOS: Entre abril de 2003 y febrero de 2006 se hospitalizaron 1 031 pacientes en las cinco UCI estudiadas, con un total de 10 293 días en los que se adquirieron 307 IAA, para una tasa de 29,8 por ciento (29,8 IAA por 1 000 días-UCI). Las tasas fueron: de 20,9 casos por 1 000 días-ventilador en neumonía asociada a respiradores (NAR); de 9,1 por 1 000 días-catéter en infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC); y de 9,6 por 1 000 días-catéter en infecciones urinarias asociadas con el uso de catéteres (IUAC). De las IAA causadas por Staphylococcus aureus, 95 por ciento se debieron a cepas resistentes a la meticilina. De las infecciones causadas por Enterobacteriaceae, 96,7 por ciento fueron resistentes a la ceftriaxona, 79,3 por ciento a la ceftazidima y 85,7 por ciento a la combinación piperacilina-tazobactam. De las IAA causadas por Pseudomonas aeruginosa, 71,3 por ciento resultaron resistentes a la ciprofloxacina, 75,5 por ciento a la ceftazidima y 27,7 por ciento al imipenem. Los pacientes con IAA en las UCI estudiadas presentaron tasas de mortalidad adicional de 15,3 por ciento (riesgo relativo [RR] = 1,79; P = 0,0149) por NAR, 27,8 por ciento (RR = 2,44; P = 0,0004) por IC-CVC y 10,7 por ciento (RR = 1,56; P = 0,2875) por IUAC. ...


Subject(s)
Humans , Catheters, Indwelling/microbiology , Catheters, Indwelling/statistics & numerical data , Cross Infection/epidemiology , Hospitals/statistics & numerical data , Infection Control , International Cooperation , Intensive Care Units/statistics & numerical data , Surgical Fixation Devices/microbiology , Surgical Fixation Devices/statistics & numerical data , Brazil/epidemiology , Cross Infection/mortality
10.
Rev. salud pública ; 9(3): 439-447, jul.-sep. 2007. tab
Article in English | LILACS (Americas) | ID: lil-467388

ABSTRACT

Objective: The present study was aimed at determining device-associated infection rates, device use rates and the microbiologic profile of nosocomial infections in a tertiary neonatal intensive care unit (ICU) in Bogotá, Colombia. Methods: Prospective nosocomial infection surveillance was implemented in a neonatal intensive care unit for 11 months in line with the High Risk Nursery component of the Colombian Nosocomial Infection Surveillance programme. Patient-days, length of stay, device use rates and device-associated nosocomial infection rates were calculated. Results: 1 998 device days were observed among 2 890 patient days during the 11 months' surveillance. Central venous catheter-related bloodstream infection was the most common device-associated infection for all birth-weight categories. 69,2 percent and 100 percent of all coagulase negative staphylococci and Staphylococcus aureus infections were methicillin resistant strains and all gram negative rods were susceptible to third generation cephalosporins, carbapenems, ciprofloxacin and piperacillin-tazobactam. Device-associated infection and device use rates in the ICU were higher than Colombian Nosocomial Infection Surveillance reports for October 2004 and reports from Colombia and other Latin-American countries. Conclusions: This surveillance identified blood-stream infection as being the most common infection in the ICU in question. Efforts should thus be directed at establishing suitable infection-control practices.


Objetivo: El objetivo del presente estudio fue determinar las tasas de infección asociadas a dispositivos médicos, las tasas de utilización y el perfil microbiológico de las infecciones hospitalarias en una unidad de terapia intensiva neonatal en Bogotá-Colombia. Métodos: Un sistema de vigilancia de infección hospitalaria fue implementado en la unidad de terapia intensiva neonatal de un hospital de tercer nivel durante un periodo de 11 meses de acuerdo al componente neonatal del sistema de vigilancia de infección hospitalaria de los estados unidos. Se calcularon los días pacientes, los días de estancia, las tasas de utilización y de infección asociadas a dispositivos invasivos. Resultados: Un total de 1 998 días dispositivos fueron observados entre 2 890 días paciente durante los 11 meses de vigilancia. La infección asociada a catéter central fue la infección más frecuente entre las diferentes categorías de peso neonatal. El 69,2 por ciento y el 100 por ciento de todos los Staphylococos coagulasa negativa y Staphylococcus aureus fueron resistentes a meticilina respectivamente, y todos los bacilos gram negativos fueron susceptibles a las Cefalosporinas de tercera generación, Carbapenemicos, Ciprofloxacina y a Piperacilina-Tazobactam. Las tasas de infección asociada a dispositivos invasivos y las tasas de utilización en nuestra unidad fueron superiores al reporte de octubre del 2004 del sistema de vigilancia de infección hospitalaria de los estados unidos y de otros trabajos realizados en Colombia y en Latinoamérica. Conclusiones: Este proceso de vigilancia ha permitido identificar que las infecciones del torrente sanguíneo comprende el principal problema de nuestra unidad y por tal motivo la necesidad de implementar adecuadas medidas de control de infecciones para disminuir la ocurrencia de esta infección debe ser la prioridad de nuestra institución.


Subject(s)
Female , Humans , Male , Bacteremia/epidemiology , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/microbiology , Equipment and Supplies/adverse effects , Equipment and Supplies/microbiology , Intensive Care Units/statistics & numerical data , Catchment Area, Health , Colombia/epidemiology , Intensive Care Units/standards , Prospective Studies , Ventilators, Mechanical/microbiology
11.
Braz. j. infect. dis ; 11(1): 96-99, Feb. 2007. tab
Article in English | LILACS (Americas) | ID: lil-454688

ABSTRACT

CVC is the main factor of risk of bloodstream infections. This study purpose was determining both etiology and pathogenesis of these infections in 80 patients who undergone gastrointestinal surgery and who worn long lasting CVC, in the institution HC-UFU. Cultures were made in nostril, skin of the insertion site, tip and catheter hub, in addition to hemoculture in those suspects of sepsis. The colonization incidence rate of the catheter tip was 12.5/ 1,000 catheter days and the CVC associate infection rate was 3.1/1,000 catheter days. Frequencies of skin, hub and catheter tip colonization were 13.8 percent, 8.9 percent and 13.3 percent, respectively. Coagulase-negative Staphylococci were the most found microorganisms in nostril (74 percent), skin (45.4 percent) and hub (75 percent) and Gram-negative bacilli (50 percent), followed by S. aureus (25 percent) the most common ones in catheter tip. Approximately 51 percent of patients received antibiotics and most of them (53.7 percent) had therapeutic purpose. The frequency of patients with clinical sepsis was 27.5 percent. Three cases of bacteremia associated with the use of CVC were detected (3.8 percent), with S. aureus in two of them and K. pneumoniae in the third one. There was not seen any association of skin and hub colonization with their presence in the catheter tip and in the blood of these patients, but S. aureus was recovered from nostril of those with sepsis by this pathogenic agent. A greater concern is suggested over preventive measures and control of these primary and secondary bloodstream, as well as catheter tip colonization.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Blood-Borne Pathogens/isolation & purification , Catheterization, Central Venous/adverse effects , Cross Infection/microbiology , Digestive System Surgical Procedures/adverse effects , Sepsis/microbiology , Candida albicans/isolation & purification , Catheters, Indwelling/adverse effects , Catheters, Indwelling/microbiology , Equipment Contamination/statistics & numerical data , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Risk Factors , Sepsis/epidemiology , Time Factors
12.
Rev. Soc. Bras. Med. Trop ; 40(1): 91-93, jan.-fev. 2007. tab
Article in Portuguese | LILACS (Americas) | ID: lil-449180

ABSTRACT

Avaliou-se o potencial de virulência de 23 leveduras isoladas de cateteres e mãos de trabalhadores em um hospital do Noroeste do Paraná. As leveduras isoladas de cateter foram mais aderentes e hidrofóbicas (P<0,05) que as leveduras isoladas das mãos. Candida não-albicans expressaram com mais intensidade os fatores de virulência avaliados.


The virulence potential of 23 yeasts recovered from intravascular catheters and the hands of workers in a hospital in the northwestern region of Paraná were evaluated. Yeasts recovered from catheters presented greater adherence and were more hydrophobic (p<0.05) than yeasts recovered from hands. Candida non-albicans species expressed the virulence factors evaluated more intensely.


Subject(s)
Humans , Candida/pathogenicity , Catheters, Indwelling/microbiology , Hand/microbiology , Personnel, Hospital , Virulence Factors , Candida/isolation & purification , Catheterization, Central Venous/instrumentation
13.
Braz. j. infect. dis ; 10(5): 346-351, Oct. 2006. tab, ilus
Article in English | LILACS (Americas) | ID: lil-440695

ABSTRACT

The cell surface hydrophobicity and adhesion to abiotic and cellular surfaces was tested in five clinical strains of Acinetobacter baumannii isolated from catheter tips. Biochemical and molecular characteristics of these strains were also studied. Hydrophobicity was characterized by a test for affinity to xylene. Adhesion to abiotic surfaces (polystyrene, formica, latex and glass) was evaluated in Petri plates using the stamp technique. Buccal epithelial cells were used for tests of adhesion to cellular surfaces. Adhesion to the catheter was evaluated by repeatedly rinsing the catheters and rolling them over nutrient agar. Molecular typing of the strains was done by the ERIC-PCR technique. The degree of hydrophobicity of the strains varied from hydrophobic to hydrophilic. All the strains adhered to the cell surfaces and to the catheters, and three of them strongly adhered to latex, polystyrene and formica. Catheter adhesion was reduced by meropenem. We found a direct relationship between the degree of bacterial hydrophobicity and adhesion to the abiotic surfaces, but not with adhesion to cellular surfaces, which suggests that different mechanisms are involved in adherence.


Subject(s)
Humans , Acinetobacter baumannii/isolation & purification , Bacterial Adhesion , Catheters, Indwelling/microbiology , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Anti-Bacterial Agents/pharmacology , Hydrophobic and Hydrophilic Interactions , Microbial Sensitivity Tests , Thienamycins/pharmacology
15.
Rev. ciênc. farm. básica apl ; 27(3): 213-220, 2006. tab
Article in English | LILACS (Americas) | ID: lil-466203

ABSTRACT

Semiquantitative (Maki) and quantitative (Brun-Buisson) culture techniques were employed in the diagnosis of catheter-related bloodstream infections(CRBSI) in patients who have a short-term central venous catheter (inserted for 30 days). The diagnosis of CRBSI was based on the results of semiquantitative and quantitative culture of material from the removed catheters. Catheter tips (118) from 100 patients were evaluated by both methods. Semiquantitative analysis revealed 34 catheters (28.8%) colonized by greater or equal 15 colonyforming units (cfu), while quantitative cultures (34 catheters, 28.8%) showed the growth of greater or equal 103 cfu/mL. Bacteremia was confirmed in four patients by isolating microorganisms of identical species from both catheters and blood samples. Using the semiquantitative culture technique on short-term central venous catheter tips, we have shown that with a cut-off level of greater or equal 15 cfu, the technique had 100.0% sensitivity, specificity of 68.4%, 25.0% positive predictive value (PPV) and 100.0% negative predictive value (NPV), efficiency of 71.4% and a prevalence of 9.5%. The quantitative method, with a cut-off limit of greater or equal 103 cfu/mL, gave identical values: the sensitivity was 100.0%, specificity 68.4%, positive predictive value (PPV) 25.0%, negative predictive value(NPV) 100.0%, efficiency 71.4% and prevalence 9.5%. We concluded that the semiquantitative and quantitative culture methods, evaluated in parallel, for the first time in Brazil, have similar sensitivity and specificity.


Subject(s)
Bacteremia/complications , Bacteremia/microbiology , Culture Media , Catheters, Indwelling/adverse effects , Catheters, Indwelling/statistics & numerical data , Catheters, Indwelling/microbiology
16.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-38152

ABSTRACT

OBJECTIVES: To study the rates of catheter associated urinary tract infection (CAUTI), Ventilator-associated pneumonia (VAP), Central venous catheter blood stream infection (CVCBSI) and surgical site infection (SSI) in Thai hospitals. The rates of the infections will be used as quality indicators. MATERIAL AND METHOD: Active surveillance in 38 hospitals in Thailand during 2003-2004. Risk stratification of NI rates and utilization of devices were calculated. Results: The rates of CAUTI, VAP, CVCBSI and SSI were obtained. Pooled means, and rates of NI at 10, 25, 50, 75 and 90 percentiles were calculated for CAUTI, VAP, CVCBSI. The infection rates were also presented for each type of hospital. The above NI rates were comparable to those reported by the National Nosocomial Infection Surveillance System (NNIS) in the United States. Surgical site infection was studied in 21 procedures with risk index categories 0-2. The rates of SSI in the present study was lower than those in the U.S. study due to different methods of study. CONCLUSION: The risk stratified rates of CAUTI, VAP, CVCBSI and SSI were obtained. They were similar to a larger scale of study in the United States. The NI rates could be used for evaluating the efficacy of NI control in Thai hospitals.


Subject(s)
Bacteremia/prevention & control , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/microbiology , Cross Infection/epidemiology , Hospitals, Teaching , Humans , Infection Control/organization & administration , Pneumonia/prevention & control , Population Surveillance , Quality Indicators, Health Care , Risk Assessment , Risk Factors , Sentinel Surveillance , Surgical Wound Infection/prevention & control , Thailand/epidemiology , Urinary Tract Infections/prevention & control , Ventilators, Mechanical/microbiology
17.
Caracas; s.n; dic. 2005. 69 p. tab, graf.
Thesis in Spanish | LILACS (Americas) | ID: lil-551791

ABSTRACT

Los accesos venosos centrales son frecuentes en las unidades de cuidados intensivos, este estudio buscó determinar los agentes patógenos que se encuentren en la punta del catéter en relación con tiempo de permanencia en pacientes del Servicio Terapia "Dr. Xavier Mugarra" del Hospital de Niños "J. M. de los Ríos", de junio a octubre de 2004. Se tomo en cuenta: tiempo de permanencia del catéter, número de luces, métodos de barrera durante la inserción, cuidado del catéter y toma de punta del catéter venoso central. Se cultivaron 23 puntas de catéter venoso obteniendo: 13 sin desarrollo bacteriano, y 10 con desarrollo bacteriano, con un tiempo promedio de permanencia de 7,6 días. Concluimos que no hubo relación entre colonización de punta de catéter con hemocultivo, sin correlación de contaminación por catéter en la población estudio.


Subject(s)
Humans , Blood-Borne Pathogens , Catheterization, Central Venous , Catheters, Indwelling/microbiology , Residence Time , Emergency Nursing , Intensive Care Units, Pediatric , Pediatric Nursing
18.
Article in English | WPRIM (Western Pacific) | ID: wprim-113960

ABSTRACT

Agranulocytosis is a rare adverse effect associated with prolonged vancomycin therapy, and is potentially serious, especially in end stage renal disease (ESRD) patients. We describe a continuous ambulatory peritoneal dialysis (CAPD) patient that developed vancomycin-induced agranulocytosis during treatment for methicillin-resistant Staphylococcus aureus (MRSA) -associated external cuff infection and pneumonia. The agranulocytosis was rapidly resolved by granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin.


Subject(s)
Aged , Agranulocytosis/chemically induced , Anti-Bacterial Agents/adverse effects , Catheters, Indwelling/microbiology , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Kidney Failure, Chronic/complications , Male , Peritoneal Dialysis, Continuous Ambulatory , Staphylococcal Infections/drug therapy , Vancomycin/adverse effects
19.
Indian Pediatr ; 2003 Sep; 40(9): 903-4
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-14034
20.
Rev. bras. anal. clin ; 34(3): 151-154, 2002. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-346055

ABSTRACT

Este trabalho caracterizou a microbiota bacteriana presente em culturas positivas de ponta de cateter no Hospital Geral de Fortaleza - SUS durante o ano de 2000, verificando as bactérias mais freqüentes e seu perfil de sensibilidade aos antimicrobianos. As pontas de cateter foram roladas em ágar sangue e ágar Mac Conkey, incubadas por 24 horas à temperatura de 35 grausC. As culturas positivas foram submetidas à identificaçäo e teste de susceptibilidade a antibióticos por metodologia automatizada (ATB Bio Mérieux). Foram realizadas um total de 217 culturas de ponta de cateter, das quais 124 foram positivas (57 porcento). As bactérias mais freqüentes foram staphylococcus sp coagulase negativa e pseudomonas aeruginosa. Dentre os estafilococos näo-produtores de coagulase, 63 porcento foram resistentes à oxacilina, sendo a Vancomicina o antibiótico mais eficiente. Quanto às pseudomonas, ao Imipenem e Colistina foram sensíveis


Subject(s)
Humans , Catheters, Indwelling/microbiology , Coagulase , Cross Infection/diagnosis , Pseudomonas Infections/microbiology , Microbial Sensitivity Tests , Drug Resistance, Microbial , Vancomycin
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