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1.
Rev. chil. infectol ; 37(5): 515-522, nov. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144245

ABSTRACT

Resumen Introducción: Las infecciones del torrente sanguíneo son un problema creciente y actualmente son una amenaza para la salud pública. La bacteriemia representa aproximadamente 15% de todas las infecciones nosocomiales y afecta a 1% de los pacientes hospitalizados. Objetivo: Describir las características clínicas, epidemiológicas y microbiológicas de episodios de bacteriemia nosocomial ocurridos en un hospital colombiano. Pacientes y Métodos: Estudio retrospectivo, observacional, de corte transversal, con inclusión de pacientes adultos, hospitalizados por el Servicio de Medicina Interna en el Hospital Universitario de Santander, Bucaramanga, Colombia, durante los años 2014 a 2016. El protocolo fue aprobado por el Comité de Ética en Investigación de la Universidad Industrial de Santander. Resultados: Se revisaron 450 historias clínicas, con 148 pacientes y 182 aislados microbianos. Los antecedentes más frecuentes fueron: hipertensión arterial (46,6%) e infección por VIH (29,7%). El sistema vascular y urinario ocuparon los sitios anatómicos más frecuentes (37,3 y 38,3%, respectivamente). La letalidad fue de 29%. Los patógenos más frecuentemente aislados fueron: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa (en suma: 49,8%) y Staphylococcus aureus 12,1%. El análisis multivariado mostró relación de la anemia con mortalidad intrahospitalaria (OR = 17,3; IC95% 2,95-102,0). Conclusiones: La bacteriemia es una infección frecuente durante la atención hospitalaria que presenta gran mortalidad. Es destacable el predominio de aislados de enterobacterias multiresistentes. El antecedente de infección por VIH es uno de los más frecuentes el que amerita ser evaluado como grupo de riesgo.


Abstract Background: Bloodstream infections are an increasing problem and currently represent a threat to public health, overcoming diseases such as HIV. Bacteremia accounts for approximately 15% of all nosocomial infections and affects 1% of all hospitalized patients. Aim: To describe the clinical, epidemiological and microbiological characteristic of episodes of nosocomial bacteremia occurring in a Colombian hospital. Methods: Retrospective, observational, cross-sectional study including adult patients, hospitalized in the internal medicine unit at the University Hospital of Santander, Bucaramanga, Colombia, during years 2014 to 2016, who met the criteria of the CDC for bloodstream infection. The protocol was approved by the Hospital Ethics Committee and by the Research Ethics Committee of the Industrial University of Santander. Results: We reviewed 450 clinical records with 148 patients and 182 microbiological isolates. 53% were male. The most frequent comorbidities were: high blood pressure (46.6%), HIV infection (29.7%). The vascular and urinary systems were the most frequent anatomical sites as the source of the infection (respectively 37.3% and 38.3%). Case fatality rate was 29%. The pathogens most frequently isolated were: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa (globally: 49.8%) and Staphylococcus aureus 12.1%. The multivariate analysis showed a relationship between anemia and in-hospital mortality (OR = 17.3, 95%CI 2.95-102.0). Conclusions: Bacteremia is a frequent infection during hospital care that presents high mortality. It is noteworthy the predominance of Enterobacteriaceae isolates with broad profiles of resistance. The history of HIV infection is one of the most frequent which deserves to be evaluated as a risk group.


Subject(s)
Humans , Male , Female , Cross Infection/drug therapy , Cross Infection/epidemiology , Bacteremia/drug therapy , Bacteremia/epidemiology , HIV Infections/drug therapy , Retrospective Studies , Colombia/epidemiology , Anti-Bacterial Agents/therapeutic use
2.
Rev. Soc. Bras. Med. Trop ; 53: e20200248, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136841

ABSTRACT

Abstract INTRODUCTION: The increase in the prevalence of multidrug-resistant Acinetobacter baumannii infections in hospital settings has rapidly emerged worldwide as a serious health problem. METHODS: This review synthetizes the epidemiology of multidrug-resistant A. baumannii, highlighting resistance mechanisms. CONCLUSIONS: Understanding the genetic mechanisms of resistance as well as the associated risk factors is critical to develop and implement adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting.


Subject(s)
Humans , Acinetobacter Infections/drug therapy , Acinetobacter Infections/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Acinetobacter baumannii , Disease Outbreaks , Drug Resistance, Multiple, Bacterial , Delivery of Health Care , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
3.
Rev. epidemiol. controle infecç ; 9(4): 281-286, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1152242

ABSTRACT

Justificativa e objetivos: Infecções Relacionadas à Assistência à Saúde (IRAS) causadas por bacilos Gram negativos multirresistentes (BGN-MDR) são consideradas um problema de saúde pública e um impacto nas taxas de mortalidade nas Unidades de Terapia Intensiva (UTI). O objetivo deste estudo foi verificar o perfil fenotípico de resistência à colistina e à tigeciclina, consideradas como último recurso terapêutico aos BGN-MDR. Métodos: Os dados foram coletados nas fichas de busca ativa do serviço de controle de infecções e prontuários médicos de pacientes internados em duas UTIs de um hospital público de Joinville, entre janeiro de 2016 e junho de 2017. Resultados: Ocorreram 256 IRAS por BGN, acometendo principalmente o gênero masculino (62%), com mediana de idade de 65 anos. Entre os BGN, 37% expressaram MDR; sendo as espécies mais frequentes: Klebsiella pneumoniae e (47%), Acinetobacter baumannii (23%) e Stenotrophomonas maltophilia (11%). A resistência de BGN-MDR à colistina e tigeciclina foi de 5% e de 12%, respectivamente; 5% dos isolados foram resistentes aos dois antibióticos. A taxa de óbito entre os pacientes com IRAS por BGN-MDR resistentes à colistina foi mais alta (60%) que aquelas à tigeciclina (45%). Conclusão: K. pneumoniae e A. baumannii produtores de carbapenemases, resistentes a colistina e tigeciclina prevaleceram entre os BGN-MDR, e estiveram associadas a maioria dos óbitos. Essas observações, junto com o alto uso de carbapenêmicos na terapia empírica, mostra a necessidade do uso racional de antimicrobianos.(AU)


Background and objectives: Healthcare-associated Infections (HAIs) caused by multidrug-resistant Gram-negative bacilli (GNB-MDR) are considered a public health problem and have an impact on mortality rates in Intensive Care Units (ICU). The aim of this study was to verify the phenotypic profile of resistance to colistin and tigecycline, considered as the last antimicrobial choice to treat BGNMDR infections. Methods: Data were collected on the active search records of the infection control service and medical records of patients admitted to two ICUs at a public hospital in Joinville between January 2016 and June 2017. Results: There were 256 HAIs caused by GNB, mainly affecting males (62%), with a median age of 65 years. Among GNBs, 37% expressed MDR; the most frequent species were: Klebsiella pneumoniae (47%), Acinetobacter baumannii (23%) and Stenotrophomonas maltophilia (11%). The resistance of GNB-MDR to colistin and tigecycline was 5% and 12%, respectively; 5% of the isolates were resistant to both antibiotics. The death rate among patients with HAIs caused by colistin-resistant GNB-MDR was higher (60%) than those to tigecycline (45%). Conclusion: Carbapenemase-producing K. pneumoniae and A. baumannii, resistant to colistin and tigecycline, prevailed among GNB-MDRs, and were associated with most deaths. These observations, coupled with the high use of carbapenems in empirical therapy, show the need for rational use of antimicrobials.(AU)


Justificación y objetivos: Las Infección nosocomial (IHs) causadas por bacilos Gram negativos multirresistentes (BGN-MDR) se consideran un problema de salud pública y un impacto en las tasas de mortalidad en las Unidades de Terapia Intensiva (UTI). El objetivo de este estudio fue verificar el perfil fenotípico de resistencia a la colistina ya la tigeciclina, consideradas como último recurso terapéutico a los BGN-MDR. Métodos: Los datos fueron recolectados en las fichas de búsqueda activa del servicio de control de infecciones y prontuarios médicos de pacientes internados en dos UTIs de un hospital público de Joinville, entre enero de 2016 y junio de 2017. Resultados: Ocurrieron 256 IHs por BGN, que afectan principalmente al género masculino (62%), con mediana de edad de 65 años. Entre los BGN, el 37% expresó MDR; siendo las especies más frecuentes: Klebsiella pneumoniae (47%), Acinetobacter baumannii (23%) y Stenotrophomonas maltophilia (11%). La resistencia de BGN-MDR a la colistina y tigeciclina fue del 5% y del 12%, respectivamente; 5% de los aislados fueron resistentes a los dos antibióticos. La tasa de muerte entre los pacientes con IH causadas por los BGN-MDR resistentes la colistina fue más alta (60%) que aquellas a tigeciclina (45%). Conclusión: K. pneumoniae y A. baumannii productoras de carbapenemases, resistentes la colistina y la tigeciclina, fueron más frecuentes entre los BGN-MDR y su asociación estuvo presente en la mayoría de las muertes. Estas observaciones, junto con el alto uso de carbapenems en la terapia empírica, muestran la necesidad de un uso racional de los antimicrobianos.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Colistin/pharmacology , Drug Resistance, Multiple, Bacterial , Tigecycline/pharmacology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/pharmacology , Phenotype , Cross Infection/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Colistin/therapeutic use , Stenotrophomonas maltophilia/drug effects , Stenotrophomonas maltophilia/genetics , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Tigecycline/therapeutic use , Gram-Negative Bacteria/genetics , Hospitalization , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/therapeutic use
4.
Vaccimonitor (La Habana, Print) ; 28(2)mayo.-ago. 2019. tab, graf
Article in English | LILACS, CUMED | ID: biblio-1094627

ABSTRACT

Proteus species are found in the human intestinal tract as part of normal flora. Proteus species are also found in multiple environmental habitats, including long-term care facilities and hospitals, and can cause both community and nosocomial infections. For a long time Proteus was known to be susceptible to beta-lactam antibiotics but nowadays they become resistant. The aim of this study was to detect the Extended-spectrum beta-lactamase (ESBL) TEM and CTX-M genes in 90 Proteus species isolated from urine and wound swabs, obtained from different hospitals in Khartoum state, Sudan, from January to August 2018. Antimicrobial sensitivity was carried out using the following set of antibiotics: amoxiclav, ceftazidime, gentamicin, meropenem, cefotaxime, ciprofloxacin, amoxicillin, ceftriaxone and cotrimoxazole. ESBL producing strains were detected by double disc diffusion synergy test and the resistance genes TEM and CTX-M were detected by Polymerase Chain Reaction (PCR). Antibiotic resistance was found: amoxicillin 40 percent, ceftazidime 25.6 percent, ceftriaxone 23.3 percent, gentamicin 22.2 percent, cotrimoxazole 21.1 percent, and cefotaxime 18.9 percent. Most of the isolates were sensitive to meropenem 92.2 percent and ciprofloxacin 86.7 percent. In double-disk diffusion synergy test, 20 isolates (22.2 percent) were found to be positive for ESBL. The PCR demonstrated that TEM gene was present in 18 isolates (90 percent). It was present alone in 11 isolates (55 percent) and in combination with CTX-M gene in seven isolates (35 percent). The percentage of ESBL producing strains of Proteus was 23.5 percent. This percentage is a bit lower than in previous studies in Sudan. In conclusion; it seems that the CTX-M gene is emerging among Proteus species in SudanAU)


Las especies de Proteus se encuentran en el tracto intestinal humano y forman parte de su flora normal. También se localizan en el medio ambiente y otros hábitats, incluyendo hospitales y diversas instituciones de salud, provocando tanto infecciones en la comunidad como nosocomiales. Durante mucho tiempo, las especies de Proteus fueron susceptibles a los antibióticos betalactámicos, pero actualmente se han tornado resistentes. El propósito de este estudio fue detectar genes de resistencia betalactamasas de espectro extendido (BLEE) TEM y CTX-M, en 90 especies de Proteus aisladas en orina y heridas, provenientes de diversos hospitales del estado de Jartum, Sudán, entre enero y agosto de 2018. La sensibilidad antimicrobiana se determinó con el siguiente juego de antibióticos: amoxiclav, ceftazidima, gentamicina, meropenem, cefotaxima, ciprofloxacina, amoxicilina, ceftriaxona y cotrimoxasol. Las cepas productoras de BLEE se detectaron mediante la técnica de sinergia de doble disco, y los genes de resistencia TEM y CTX-M mediante Reacción en Cadena de la Polimerasa (PCR). Se encontró resistencia antibiótica: amoxicilina 40 por ciento, ceftazidima 25,6 por ciento, ceftriaxona 23,3 por ciento, gentamicina 22,2 por ciento, cotrimoxasol 21,1 por ciento y cefotaxima 18,9 por ciento. La mayor parte de los aislamientos fueron sensibles a meropenem (92,2 por ciento) y ciprofloxacina (86,7 por ciento). Con la técnica de sinergia de doble disco se detectó positividad a BLEE en 20 aislamientos (22,2 por ciento). Mediante PCR se demostró que el gen que codifica TEM estaba presente en 18 aislamientos (90 por ciento); de forma aislada en 11 aislamientos (55 por ciento) y combinado con el gen CTX-M en los otros siete (35 por ciento). El porcentaje de cepas de Proteus productoras de BLEE fue de 23,5 por ciento. Este valor es ligeramente inferior que los detectados en estudios previos en Sudán. En conclusión, hay evidencias de que el gen CTX-M está emergiendo entre las especies de Proteus en Sudán(AU)


Subject(s)
Drug Resistance, Microbial/drug effects , Cross Infection/drug therapy , Disk Diffusion Antimicrobial Tests/methods , Proteus Infections/epidemiology , Sudan
5.
Rev. saúde pública (Online) ; 53: 68, 2019. tab, graf
Article in English | LILACS | ID: biblio-1020892

ABSTRACT

ABSTRACT OBJECTIVE To assess whether the incidence of hospital infection by a resistant microorganism decreased after the implementation of the restrictive measure of the National Health Surveillance Agency for the commercialization of antimicrobials. METHODS A historical cohort study of medical records of adult patients admitted to a general and public hospital from May 2010 to July 2011. A cohort was formed with patients admitted in the period before the restrictive measure for the commercialization of antimicrobials (Phase I) and a second cohort was formed with patients admitted after the implementation of the restrictive measure (Phase II). RESULTS The instantaneous risk of hospital infection by a resistant microorganism was estimated at seven by 1,000 people-time (95%CI 0.006-0.008) in Phase I, and four by 1,000 people-time (95%CI 0.003-0.005) in Phase II of the study. The differences between the survival curves in the different phases of the study and stratified by age group were also significant (p < 0.05). CONCLUSIONS The results suggest that the implementation of the restrictive measure of the commercialization of antimicrobials by the National Health Surveillance Agency reduced the incidence of hospital infection by a resistant microorganism.


RESUMO OBJETIVO Avaliar se a incidência de infecção hospitalar por microrganismo resistente diminuiu após a implementação da medida restritiva da Agência Nacional de Vigilância Sanitária para comercialização de antimicrobianos. MÉTODOS Estudo de coorte histórica de registros de prontuários de pacientes adultos admitidos para internação em um hospital geral e público no período de maio de 2010 a julho de 2011. Foi formada uma coorte com pacientes internados em período anterior à medida restritiva para comercialização de antimicrobianos (Fase I) e uma segunda coorte com pacientes admitidos após a implantação da medida restritiva (Fase II). RESULTADOS O risco instantâneo de infecção hospitalar por microrganismo resistente foi estimado em sete por 1.000 pessoas-tempo (IC95% 0,006-0,008) na Fase I, e quatro por 1.000 pessoas-tempo (IC95% 0,003-0,005) na Fase II do estudo. As diferenças entre as curvas de sobrevida nas diferentes fases do estudo e estratificadas pela faixa etária também foram significativas (p < 0,05). CONCLUSÕES Os resultados sugerem que a implantação da medida restritiva de comercialização de antimicrobianos pela Agência Nacional de Vigilância Sanitária reduziu a incidência de infecção hospitalar por microrganismo resistente.


Subject(s)
Humans , Male , Female , Drug Resistance, Microbial , Cross Infection/prevention & control , Cross Infection/drug therapy , Prescription Drug Overuse/legislation & jurisprudence , Anti-Bacterial Agents/administration & dosage , beta-Lactamases/drug effects , Brazil , Cohort Studies , Infection Control/methods , Drug Monitoring , Drug Utilization/legislation & jurisprudence , Prescription Drug Overuse/adverse effects , Prescription Drug Overuse/statistics & numerical data , Middle Aged
6.
Braz. j. infect. dis ; 22(4): 328-337, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-974219

ABSTRACT

ABSTRACT Background Technologies and life support management have enhanced the survival of preterm infants. The immune system of newborns is immature, which contributes to the occurrence of healthcare-associated infections. The overlap of several conditions with neonatal sepsis and the difficulty of diagnosis and laboratory confirmation during this period result in a tendency to over-treat neonatal sepsis. The use of antimicrobial agents is a risk factor for multidrug-resistant bacterial infections. This work aimed to perform a systematic review of the relationship between inadequate use of antimicrobial agents and increase in neonatal sepsis related to healthcare assistance, due to bacterial resistance. Methods Our population, exposition, comparison, outcome and study type was as follows: P: hospitalized neonates with sepsis diagnosis, E: inappropriate use of antimicrobial agents, C: adequate use of antimicrobial agents or no indication of infection, O: resistant bacterial infection, and S: original studies. We performed searches in the PubMed, Scopus, Virtual Health Library (Scielo, LILACS, and MEDLINE), and Embase without limits on time, language, and the references of the articles found. Fourteen studies were included and assessed using the Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle, and the Strengthening the Reporting of Observacional Studies in Epidemiology methodologies. Results All studies found were observational and started with a low-quality evidence level in the Grading of Recommendations, Assessment, Development, and Evaluation. Conclusions Despite their low-quality evidence, the studies demonstrated the association between inadequate use of antimicrobial agents and increase of neonatal resistant bacterial healthcare-associated infections in neonatal units. However, there is significant difficulty in conducting high-quality studies in this population due to ethical issues tied to randomized trials. Therefore, new studies should be encouraged to recommend adequate treatment of newborns without increasing the risk of healthcare-associated infections by multidrug-resistant bacteria.


Subject(s)
Humans , Infant, Newborn , Cross Infection/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Drug Resistance, Multiple, Bacterial , Neonatal Sepsis/drug therapy , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Risk Factors , Gram-Negative Bacterial Infections/microbiology , Evidence-Based Medicine , Neonatal Sepsis/microbiology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/adverse effects
7.
Rev. chil. infectol ; 34(5): 441-446, oct. 2017. tab
Article in Spanish | LILACS | ID: biblio-899740

ABSTRACT

Resumen Introducción: La epidemiología de la candidemia en Chile es poco conocida, a pesar de ser una enfermedad frecuente y grave. Objetivos: Analizar la incidencia y perfil de susceptibilidad in vitro de especies del género Candida causantes de candidemia en el Hospital Base Valdivia. Material y Métodos: Se identificó todos los casos de candidemia ocurridos en la institución entre marzo de 2009 y agosto de 2011. Se estudió la distribución de especies y susceptibilidad in vitro por el método de disco difusión. Resultados: Se estudiaron 27 episodios de candidemia. La incidencia varió de 0,3 a 0,7 por 1.000 egresos (según servicio clínico). Fueron factores de riesgo: la hospitalización, uso previo de antimicrobianos, edad avanzada y enfermedad de base (insuficiencia renal, enfermedad cardiaca y pulmonar). La especie más frecuente fue C. albicans seguida de C. tropicalis, C. glabrata y C. krusei. Voriconazol fue el antifúngico con mejor actividad in vitro y hubo resultados variables para anfotericina B, fluconazol e itraconazol. Discusión: La incidencia encontrada fue superior a la de países desarrollados. Candida albicans, constituye la especie más frecuente, con alta sensibilidad in vitro a fluconazol, debiendo ser vigiladas las especies de Candida no albicans. Es fundamental desarrollar nuevas investigaciones para detectar potenciales variaciones epidemiológicas.


Background: Candidemia disease in Chile is not very known, despite being a very common and serious disease. Aim: To analyze incidence and susceptibility profile of species from the genus Candida in Hospital Base Valdivia. Material and Methods: All candidemia cases presented between March 2009 and August 2011 in our institution were identified. Species distribution and susceptibility were studied through the disk diffusion method. Results: Twenty-seven candidemia episodes were studied. Incidence varied from 0.3 to 0.7 by a thousand discharges (according to clinical service). Risk factors were hospitalization, preliminary use of antibiotics, aged people and underlying disease (renal failure, heart and lung disease). The most frequent species was C. albicans, followed by C. tropicalis, C. glabrata and C. krusei. Voriconazole was the antifungal showing the best in vitro performance. Amphotericin B, fluconazole and itraconazole presented variable results. Discussion: Incidence found was superior to that described in developed countries. Candida albicans constitute the most frequent species, with high sensitivity levels to fluconazole; Candida no albicans species must be monitored. Developing new research on the topic appears as fundamental to detect potential epidemiological variations.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Candida/isolation & purification , Cross Infection/drug therapy , Cross Infection/epidemiology , Candidemia/drug therapy , Candidemia/epidemiology , Antifungal Agents/therapeutic use , Candida/drug effects , Microbial Sensitivity Tests , Chile/epidemiology , Cross Infection/microbiology , Incidence , Retrospective Studies , Risk Factors , Sex Distribution , Age Distribution , Drug Resistance, Fungal , Candidemia/microbiology
8.
Rev. chil. infectol ; 34(5): 431-440, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899739

ABSTRACT

Resumen Introducción: La epidemiologia de las candidemias varía en cada región. Objetivos: Conocer la epidemiología de las candidemias en un hospital durante 16 años. Material y Métodos: Se revisaron los episodios de candidemia ocurridos en el Hospital de Clínicas de Buenos Aires desde 01/01/98 al 31/12/13. Resultados: Se identificaron 374 episodios de candidemia. La incidencia fue de 2,21/1.000 egresos y aumentó de 1,96 (1998-2005) a 2,25 (2006-2013) (p = 0,023). Se diagnosticaron: 5,4% en neonatos, 1,7% en lactantes, 6,5% en niños mayores, 31,8% en adultos y 52,7% en adultos mayores de 64 años. Los episodios fueron causados por C. albicans (40,9%), C. parapsilosis (21,7%), C. tropicalis (15,5%), C. glabrata (13,9%), otras especies de Candida (5,1%) y candidemias multiespecies (2,9%). El 5,3% de los aislados fue resistente a fluconazol. Setenta y cuatro por ciento de los pacientes recibió tratamiento; 70,3% lo inició con fluconazol, 25% con anfotericina B desoxicolato y 4,7% con equinocandinas o anfotericinas lipídicas. Se retiró 81% de los catéteres venosos centrales. La mortalidad fue de 47,9%, pero fue de 60,8% para los adultos mayores. Conclusión: La incidencia de candidemias se incrementó a través de los años, fue mayor en los adultos mayores y esta población tuvo peor evolución.


Background: The epidemiology of candidemia vary by region. Aim: To determine the epidemiology of candidemia in a hospital for 16 years. Material and Methods: Episodes of candidemia occurred in the Hospital de Clinicas of Buenos Aires were reviewed, from 01/01/98 to 31/12/13. Results: 374 episodes of candidemia were identified. The incidence was 2.21/1,000 discharges and increased from 1.96 (1998-2005) to 2.25 (2006-2013) (p = 0.023). Candidemia was diagnosed: 5.4% in neonates, 1.7% in infants, 6.5% in children, 31.8% in adults and 52.7% in elderly adults over 64 years old. The episodes were caused by C. albicans (40.9%), C. parapsilosis (21.7%), C. tropicalis (15.5%), C. glabrata (13.9%), other species of Candida (5.1%) and more than one species of Candida (2.9%). The 5.3% of the isolates were resistant to fluconazole. 74% of patients were treated. Initial treatments were with fluconazole (70.3%), amphotericin B deoxycholate (25%), echinocandins or lipidic amphotericin (4,7%). The 81% of central venous catheters were taken off. Mortality rate was of 47.9%, but in the elderly adults was of 60.8%. Conclusion: The incidence of candidemia showed an increase over the years. It was higher in the elderly adults, being the group with worse outcomes.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Candida/isolation & purification , Fluconazole/therapeutic use , Cross Infection/drug therapy , Cross Infection/epidemiology , Candidemia/drug therapy , Candidemia/epidemiology , Antifungal Agents/therapeutic use , Argentina/epidemiology , Time Factors , Candida/drug effects , Microbial Sensitivity Tests , Cross Infection/microbiology , Incidence , Multivariate Analysis , Retrospective Studies , Risk Factors , Age Distribution , Drug Resistance, Fungal , Candidemia/microbiology , Central Venous Catheters/adverse effects , Hospitals, University
9.
Rev. med. interna Guatem ; 21(1): 17-20, ene.-abr. 2017. ilus
Article in Spanish | LILACS | ID: biblio-995194

ABSTRACT

Elizabethkingia meningoseptica es un bacilo gram negativo no fermentador, no móvil, y oxidasa positivo, ampliamente distribuido en la naturaleza pero poco frecuente en humanos, en quienes se considera un patógeno oportunista, actualmente denominado emergente. En el ambiente hospitalario se ha encontrado en superficies húmedas y en equipos médicos, soluciones que habitualmente se utilizan de forma intravenosa, y en medicamentos de reconstitución. Puede causar infección en personas inmunocomprometidas o con enfermedades debilitantes concomitantes. Además, posee enzimas de resistencia frente a los antibióticos prescritos usualmente contra las bacterias gram negativas. Se presenta un caso de bacteriemia por E. meningoseptica en un paciente con antecedente de enfermedad renal crónica, quien recibía tratamiento hemodíalítico 3 veces por semana, desde hace 2 años, al ingreso se documentó infección del sitio de inserción del catéter venoso central, y posteriormente se aisló en los hemocultivos periféricos el crecimiento de la bacteria E. meningoseptica, el paciente cumplió tratamiento con trimetroprim-sulfametoxazol por 14 días con adecuada evolución clínica, sin complicaciones...(AU)


Elizabethkingia meningoseptica is a non fermenter bacilli gram negative, non-mobile, and positive oxidase, widely distributed in nature but rare in humans, in whom it is considered an opportunistic pathogen, now called emerging. In the hospital environment it was found on wet surfaces and medical equipment, solutions usually used intravenously, and drug reconstitution. It can cause infection in immunocompromised or with concomitant debilitating diseases people. It also has resistance to enzymes usually prescribed antibiotics against gram negative bacteria. A case of bacteremia is presented by E. meningoseptica in a patient with a history of chronic kidney disease, who received hemodialysis 3 times a week, for 2 years, entry site infection insertion of central venous catheter was documented and later was isolated from peripheral blood cultures the growth of bacteria E. meningoseptica, the patient completed treatment with trimethoprim-sulfamethoxazole for 14 days with adequate clinical course without complications...(AU)


Subject(s)
Humans , Male , Adult , Bacteria/chemistry , Cross Infection/drug therapy , Bacteremia/diagnosis , Gram-Negative Facultatively Anaerobic Rods/chemistry , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , Guatemala
10.
Rev. argent. microbiol ; 49(1): 24-31, mar. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-843180

ABSTRACT

Se realizó una revisión retrospectiva durante 12 años de las infecciones por Staphylococcus aureus en pacientes adultos (PA) y pediátricos (PP) asistidos en el Hospital Interzonal General de Agudos Evita de Lanús, para conocer la incidencia, los focos y el origen de la infección, y analizar el perfil de resistencia antimicrobiana. Se documentaron 2125 casos de infección en PA y 361 en PP. La incidencia de casos en PA descendió significativamente en el último trienio (χ²; p < 0,05); en los PP aumentó significativamente durante los últimos 5 años (χ²; p < 0,0001). En ambas poblaciones se detectó un aumento significativo en las infecciones de piel y estructuras asociadas (PEA), de bacteriemias a punto de partida de un foco en PEA y de infecciones por S. aureus de inicio en el hospital (χ²; p < 0,005). La meticilino-resistencia (SAMR) aumentó del 28 al 78% en PP; en PA se mantuvo alrededor del 50%, con reducción significativa de la resistencia acompañante a antimicrobianos no betalactámicos en los SAMR de ambas poblaciones. En S. aureus documentados de infecciones de inicio en la comunidad (SAMR-CO) del último trienio, el porcentaje de meticilino-resistencia resultó del 57% en PP y 37% en PA; en infecciones con inicio en el hospital fue del 43 y el 63%, respectivamente. Si bien demostramos que S. aureus continúa siendo un patógeno asociado al ámbito nosocomial, hubo un aumento de infecciones por SAMR-CO, con compromiso en PEA en ambas poblaciones.


A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi²; p < 0.05); in PP it increased significantly during the last five years (χ²; p < 0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ²; p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-β-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.


Subject(s)
Humans , Male , Female , Staphylococcal Infections/etiology , Staphylococcal Infections/epidemiology , Cross Infection/epidemiology , Staphylococcus aureus/drug effects , Cross Infection/drug therapy , Incidence , Methicillin-Resistant Staphylococcus aureus
11.
Rev. gaúch. enferm ; 38(2): e58793, 2017. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-901590

ABSTRACT

RESUMO Objetivo Avaliar a incidência de flebite durante o uso de cateter intravenoso periférico (CIP) e pós-infusional e analisar a associação com fatores de risco em pacientes hospitalizados. Método Estudo de coorte com 165 pacientes adultos internados em hospital universitário de Porto Alegre que totalizaram 447 acessos no período de dezembro 2014 a fevereiro 2015. A coleta dos dados foi diária, e a análise dos dados ocorreu pela estatística descritiva e analítica. Resultados A incidência de flebite durante o uso do CIP foi de 7,15% e de flebite pós-infusional, 22,9%. A flebite durante o uso do cateter associou-se com a Amoxicilina + Ácido Clavulânico. A flebite pós-infusional apresentou associação do grau de gravidade com a idade e com o uso de Amoxacilina + Ácido Clavulânico, Cloridrato de Tramadol e Anfotericina. Conclusão A incidência de flebite pós-infusional mostrou-se um indicador importante para a análise do cenário da qualidade da assistência em saúde.


RESUMEN Objetivo Evaluar la incidencia de flebitis en el uso de catéter periférico intravenoso (CIP) y posinfusional y analizar la asociación con los factores de riesgo en pacientes hospitalizados. Método Estudio de cohorte con 165 pacientes adultos ingresados en un hospital universitario de Porto Alegre, que ascendió a 447 accesos de diciembre 2014 a febrero de 2015. La recolección de datos fue diaria y el análisis de datos fue mediante estadística descriptiva y analítica. Resultados La incidencia de flebitis durante el uso de catéter periférico intravenoso fue del 7,15% y de la flebitis posinfusional fue del 22,9%. La flebitis durante el uso del catéter se asoció con el uso de Amoxicilina + Ácido clavulánico. La flebitis posinfusional presentó una asociación del grado de gravedad con la edad, y con el uso de Amoxicilina + Ácido clavulánico, Clorhidrato de tramadol y Anfotericina. Conclusión La incidencia de flebitis posinfuncional mostró ser un indicador importante para el análisis del escenario de la calidad de atención en salud.


ABSTRACT Objective to determine the incidence of phlebitis during and after the use of peripheral intravenous catheter (PIC), and analyse the association of this complication with risk factors. Methods cohort study with 165 adult patients admitted to a university hospital in Porto Alegre, totalling 447 accesses, from December 2014 to February 2015. Data were collected on a daily basis and analysed by means of descriptive and analytical statistics. Results The incidence of phlebitis during PIC was 7.15% and the incidence of post-infusion phlebitis was 22.9%. Phlebitis during catheter use was associated with the use of Amoxicillin + Clavulanic Acid. The grade of post-infusion phlebitis was associated with age and use of Amoxicillin + Clavulanic Acid, Tramadol Hydrochloride, and Amphotericin. Conclusion The incidence of post-infusion phlebitis proved to be an important indicator to analyse the quality of the healthcare setting.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Phlebitis/epidemiology , Cross Infection/epidemiology , Catheter-Related Infections/epidemiology , Inpatients/statistics & numerical data , Phlebitis/etiology , Phlebitis/drug therapy , Tramadol/therapeutic use , Infusions, Intravenous , Catheterization, Peripheral/adverse effects , Amphotericin B/therapeutic use , Cross Infection/etiology , Cross Infection/drug therapy , Incidence , Age Factors , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Catheter-Related Infections/etiology , Catheter-Related Infections/drug therapy , Hospitals, University/statistics & numerical data , Middle Aged , Anti-Bacterial Agents/therapeutic use
13.
Yonsei Medical Journal ; : 180-186, 2017.
Article in English | WPRIM | ID: wpr-126258

ABSTRACT

PURPOSE: Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients. MATERIALS AND METHODS: We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. RESULTS: Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality. CONCLUSION: Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.


Subject(s)
Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Cross Infection/drug therapy , Drug Resistance, Multiple, Bacterial , Female , Hospital Mortality , Humans , Male , Nursing Homes , Odds Ratio , Pneumonia, Bacterial/drug therapy , Retrospective Studies
14.
Salud pública Méx ; 58(4): 446-452, jul.-ago. 2016. tab, graf
Article in Spanish | LILACS | ID: lil-795411

ABSTRACT

Resumen: Objetivo: Describir los patrones de resistencia bacteriana en cultivos de orina de pacientes de un hospital oncológico en la Ciudad de México, de 2004 a 2013. Material y métodos: Se obtuvo el porcentaje de susceptibilidad para diferentes antibióticos, describiendo por separado las bacterias multidrogorresistentes (MDR). Se analizaron por separado las cepas obtenidas de pacientes hospitalizados de las de la comunidad. Resultados: Se realizaron 51 202 cultivos, de los cuales se identificaron 14 480 bacterias (28.3%). De éstas, se reportaron 11 427 Gram negativos (78.9%); 2 080 Gram positivos (14.4%); y 973 (6.6%) levaduras. Escherichia coli fue el principal microorganismo aislado (56.1%); 24% de las cepas de la comunidad y 66% de las nosocomiales fueron productoras de beta-lactamasas de espectro extendido (BLEE). Klebsiella pneumoniae se identificó en 705 cultivos (4.8%), 115 de los cuales fueron BLEE (16%): 13.1% de la comunidad y 29.8% nosocomiales. Pseudomonas aeruginosa se identificó en 593 cultivos (4.1%): 9% de la comunidad y 51% nosocomiales. Conclusiones: Las cepas MDR son mucho más frecuentes en muestras de origen nosocomial. Es prioritario intensificar el uso racional de antibióticos en la comunidad y el programa de desescalamiento de antimicrobianos en el hospital.


Abstract: Objective: To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013. Materials and methods: We included the strains obtained from urine cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics. Results: 51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive. In 11 427 samples Gram negative (79%) were isolated, 2 080 Gram positive (14.4%), and 973 yeasts (6.6%). Escherichia coli was the most frequent bacteria identified (56.1%); 24% of the community strains and 65.7% of the nosocomial were extended-spectrum beta-lactamase producers (ESBL). Klebsiella pneumoniae was isolated in 705 samples (4.8%); 115 were ESBL (16%), 13.1% from community and 29.8% from nosocomial source. Pseudomonas aeruginosa was identified in 593 cultures (4.1%): 9% from community and 51% nosocomial. Conclusions: MDR bacteria were more frequent in nosocomial isolates. It should be a priority to intensify the rational use of antimicrobials in the community and antibiotic stewardship in the hospital.


Subject(s)
Humans , Adult , Bacteriuria/microbiology , Urinary Tract Infections/microbiology , Urine/microbiology , Drug Resistance, Multiple, Bacterial , Neoplasms/epidemiology , Bacteriuria/epidemiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , Cancer Care Facilities , Candidiasis/drug therapy , Comorbidity , Cross Infection/drug therapy , Follow-Up Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Tertiary Care Centers , Anti-Bacterial Agents/therapeutic use
15.
Rev. Soc. Bras. Med. Trop ; 49(1): 130-134, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-776530

ABSTRACT

Abstract: New Delhi metallo-beta-lactamase-1 (NDM-1) is a bacterial enzyme that renders the bacteria resistant to a variety of beta-lactam antibiotics. A 20-year-old man was hospitalized several times for surgical treatment and complications caused by a right-sided vestibular schwannoma. Although the patient acquired several multidrug-resistant infections, this study focuses on the NDM-1-producing Acinetobacter spp. infection. As it was resistant to all antimicrobials tested, the medical team developed a 20-day regimen of 750mg/day metronidazole, 2,000,000IU/day polymyxin B, and 100mg/day tigecycline. The treatment was effective, and the patient recovered and was discharged from the hospital.


Subject(s)
Humans , Male , Young Adult , Acinetobacter/enzymology , beta-Lactamases , Acinetobacter Infections/microbiology , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/therapeutic use , Acinetobacter/drug effects , Acinetobacter Infections/drug therapy , Microbial Sensitivity Tests , Cross Infection/drug therapy , Treatment Outcome , Anti-Bacterial Agents/pharmacology
16.
Rev. Nac. (Itauguá) ; 8(2): 46-61, dic 2016.
Article in Spanish | LILACS, BDNPAR | ID: biblio-884757

ABSTRACT

RESUMEN Introducción: las infecciones asociadas a cuidados de la salud, conocidas también como infecciones nosocomiales (IN), son un problema relevante de salud pública, se asocian con altas tasas de morbilidad y mortalidad, lo que se traduce en un incremento en los días de hospitalización y los costos de atención. Objetivos: determinar los gérmenes intrahospitalarios más frecuentes y su sensibilidad antibiótica en la sala de Clínica Médica del Hospital Regional de Encarnación periodo 2014-2015. Metodología: estudio descriptivo, observacional de corte transversal, prospectivo, de prevalencia y con componente analítico. Resultados: se evaluaron pacientes hospitalizados encontrándose 114 (6%) pacientes con infecciones intrahospitalarias. El perfil epidemiológico se caracterizó por predomino del sexo femenino (53%), con edad media 56,5 ± 22,5 años y una estancia hospitalaria prolongada. Los aislamientos fueron más frecuentes en orina. Las comorbilidades más frecuentes fueron la hipertensión arterial y la diabetes mellitus. El germen más frecuente aislado fue Klebsiella pneumoniae, con una sensibilidad solo a amikacina y cabapenemes, con 64% BLEE(+) y 20% KPC, seguido por Echerichia coli y Staphylococcus aureus con buena sensibilidad a oxacilina. Conclusión: se halló 6% de infecciones intrahospitalarias y el germen más frecuente fue K. pneumoniae


ABSTRACT Introduction: infectious related to health care, also known as nosocomial infections (NI) are an important public health problem, are associated with high rates of morbidity and mortality, resulting in an increase in days of hospitalization and costs. Objectives: to determine the most frequent nosocomial germs and antibiotic sensitivity in a Medical Ward of the Regional Hospital of Encarnación 2014-2015. Methodology: descriptive, observational cross-sectional study with prospective approach, and analytical component. Results: Hospitalized patients were evaluated and were found 114 (6%) patients with nosocomial infections, below the global average. The epidemiological profile, were characterized by predominance of females 53%, aged 56.5 ± 22.5 years. And a prolonged hospital stay. The germs more common commouly isolated were in urine, the more frequent comorbidities were hypertension and diabetes mellitus. The most frequent isolated germ was Klebsiella pneumoniae, with a sensitivity only to amikacin and Cabapenemes, followed by a Escherichia coli and Staphylococcus aureus oxacillin with good sensitivity. Conclusions: 6% of nosocomial infections were found and the more frequent isolated germ was K. pneumoniae


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Cross Infection/epidemiology , Paraguay/epidemiology , Klebsiella Infections/drug therapy , Klebsiella Infections/epidemiology , Carbapenems/therapeutic use , Cross Infection/drug therapy , Prevalence , Cross-Sectional Studies , Prospective Studies , Drug Resistance, Bacterial , Escherichia coli/drug effects , Escherichia coli Infections/drug therapy , Escherichia coli Infections/epidemiology , Klebsiella pneumoniae/drug effects , Length of Stay , Anti-Bacterial Agents/therapeutic use
17.
J. pediatr. (Rio J.) ; 91(5): 435-441, Sept.-Oct. 2015. tab
Article in English | LILACS | ID: lil-766176

ABSTRACT

ABSTRACT OBJECTIVE: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). METHODS: Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. RESULTS: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. CONCLUSIONS: Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.


RESUMO OBJETIVO: Este estudo visou a avaliar os preditores e resultados associados às infecções por bactérias gram-negativas multirresistentes (BGN-MR) em uma unidade de terapia intensiva pediátrica oncológica (UTIP). MÉTODOS: Foram coletados dados com relação a todos os episódios de infecção por BGN que ocorreram em uma UTIP entre janeiro de 2009 e dezembro de 2012. As infecções por BGN foram divididas em dois grupos para comparação: 1) infecções atribuídas a BGN-MR e 2) infecções atribuídas a BGN não multirresistente. As variáveis de interesse incluíram idade, sexo, presença de tumor sólido ou malignidade hematológica, câncer, uso de cateter venoso central, infecção anterior por Pseudomonas aeruginosa, infecção hospitalar, neutropenia nos sete dias anteriores, duração da neutropenia, tempo de internação antes da UTI, duração da internação na UTI e uso de quaisquer dos seguintes nos 30 dias anteriores: agentes antimicrobianos, corticosteroides, quimioterapia ou radioterapia. Outras variáveis incluíram: tratamento antimicrobiano inicial adequado, tratamento antimicrobiano definitivo inadequado, duração do uso de antibióticos adequados, tempo de início da terapia antibiótica adequada, mortalidade em sete dias e mortalidade em 30 dias. RESULTADOS: As análises de regressão logística multivariada mostraram relações significativas entre as BGN-MR e as doenças hematológicas (razão de chance (RC) 5,262; intervalo de confiança de 95% (IC de 95%) 1,282-21,594; p = 0,021) e infecções hospitalares (RC 18,360; IC de 95% 1,778-189,560; p = 0,015). Houve diferenças significativas entre os pacientes com BGN-MR e BGN não MR com relação às seguintes variáveis: recebimento de terapia antibiótica empírica inicial inadequada, tempo para início do tratamento antibiótico adequado e recebimento de terapia antibiótica inadequada. CONCLUSÕES: A malignidade hematológica e a infecção hospitalar foram significativamente associadas à infecção por BGN-MR nessa amostra de pacientes pediátricos oncológicos.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/drug effects , Gram-Negative Bacterial Infections/microbiology , Hematologic Neoplasms/microbiology , Pseudomonas Infections/microbiology , Acinetobacter Infections/microbiology , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Cross Infection/drug therapy , Cross Infection/mortality , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/mortality , Hematologic Neoplasms/drug therapy , Hematologic Neoplasms/mortality , Intensive Care Units, Pediatric/statistics & numerical data , Length of Stay/statistics & numerical data , Pseudomonas aeruginosa/isolation & purification , Risk Factors , Treatment Outcome
18.
Colomb. med ; 46(2): 60-65, Apr.-June 2015. tab
Article in English | LILACS | ID: lil-757932

ABSTRACT

Introduction: Healthcare-Associated Infections (HAI) are a challenge for patient safety in the hospitals. Infection control committees (ICC) should follow CDC definitions when monitoring HAI. The handmade method of epidemiological surveillance (ES) may affect the sensitivity and specificity of the monitoring system, while electronic surveillance can improve the performance, quality and traceability of recorded information. Objective: To assess the implementation of a strategy for electronic surveillance of HAI, Bacterial Resistance and Antimicrobial Consumption by the ICC of 23 high-complexity clinics and hospitals in Colombia, during the period 2012-2013. Methods: An observational study evaluating the introduction of electronic tools in the ICC was performed; we evaluated the structure and operation of the ICC, the degree of incorporation of the software HAI Solutions and the adherence to record the required information. Results: Thirty-eight percent of hospitals (8/23) had active surveillance strategies with standard criteria of the CDC, and 87% of institutions adhered to the module of identification of cases using the HAI Solutions software. In contrast, compliance with the diligence of the risk factors for device-associated HAIs was 33%.


Introducción: Las infecciones asociadas a la atención en salud (IAAS) son un reto para la seguridad del paciente. Los comités de infecciones hospitalarios (CIH) deben realizar una vigilancia epidemiológica (VE) de las IAAS siguiendo los criterios de los Centros para el Control y Prevención de Enfermedades - EE.UU (CDC). La VE manual afecta la sensibilidad y especificidad del sistema de vigilancia, mientras que la VE electrónica mejora el desempeño, calidad y trazabilidad de la información registrada. Objetivo: Evaluar la implementación de una estrategia para la VE electrónica de las IAAS, resistencia bacteriana, consumo de antimicrobianos y características de los CIH en 23 clínicas y hospitales de alta complejidad en Colombia, en el periodo 2012-2013. Métodos: Se realizó un estudio observacional descriptivo de la introducción de herramientas informáticas en los CIH, evaluando la estructura y funcionamiento de los CIH, el grado de incorporación del software HAI Solutions y la cumplimiento al registro de la información requerida. Resultados: El 38% de las clínicas y hospitales (8/23) presentaron estrategias de vigilancia epidemiológica activa con criterios estándar del CDC. El 87% de las instituciones se adhirieron al módulo de captación de casos del software HAI Solutions, y el cumplimiento del diligenciamiento de los factores de riesgo de las IAAS asociadas a dispositivos fue del 33%. Conclusiones: La introducción del modelo de VE electrónica podría lograr un mayor cumplimiento a un modelo de vigilancia epidemiológica activo, estandarizado y prospectivo, contribuyendo al mejoramiento en la validez y calidad de la información registrada.


Subject(s)
Humans , Cross Infection/epidemiology , Epidemiological Monitoring , Infection Control/methods , Software , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/therapeutic use , Colombia/epidemiology , Cross Infection/drug therapy , Cross Infection/prevention & control , Drug Resistance, Bacterial , Risk Factors , Sensitivity and Specificity
19.
Braz. j. infect. dis ; 19(2): 156-162, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-746510

ABSTRACT

Objective: The aim of this article is to compare the efficacy and safety of doripenem for bacterial infections. Methods: We included six randomized clinical trials identified from PubMed and Embase up to July 31, 2014. The included trials compared efficacy and safety of doripenem for complicated intra-abdominal infections, complicated urinary tract infection, nosocomial pneumonia, and acute biliary tract infection. The meta-analysis was carried on by the statistical software of Review Manager, version 5.2. Results: Compared with empirical antimicrobial agents on overall treatment efficacy, doripenem was associated with similar clinical and microbiological treatment success rates (for the clinical evaluable population, odds ratio [OR] = 1.26, 95% confidence interval [CI] 0.93-1.69, p = 0.13; for clinical modified intent-to-treatment population, OR = 0.88, 95% CI 0.55-1.41, p = 0.60; for microbiology evaluable population, OR = 1.16, 95% CI 0.90-1.50, p = 0.26; for microbiological modified intent-to-treatment (m-mITT), OR = 0.98, 95% CI 0.81-1.20, p = 0.87). We compared incidence of adverse events and all-cause mortality to analyze treatment safety. The outcomes suggested that doripenem was similar to comparators in terms of incidence of adverse events and all-cause mortality on modified intent-to-treatment population (for incidence of AEs, OR = 1.10, 95% CI 0.90-1.35, p = 0.33; for all-cause mortality, OR = 1.08, 95% CI 0.77-1.51, p = 0.67). In nosocomial pneumonia and ventilator-associated pneumonia treatment, doripenem was not inferior to other antibacterial agents in terms of efficacy and safety. Conclusion: From this meta-analysis, we can conclude that doripenem is as valuable and well-tolerated than empirical antimicrobial agents for complicated intra-abdominal infections, complicated urinary tract infection, acute biliary tract infection and nosocomial pneumonia treatment. .


Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Carbapenems/therapeutic use , Cross Infection/drug therapy , Acute Disease , Anti-Bacterial Agents/adverse effects , Carbapenems/adverse effects , Cholangitis/drug therapy , Pneumonia, Bacterial/drug therapy , Pneumonia, Ventilator-Associated/drug therapy , Randomized Controlled Trials as Topic , Urinary Tract Infections/drug therapy
20.
Rev. bras. ter. intensiva ; 27(1): 44-50, Jan-Mar/2015. tab, graf
Article in Spanish | LILACS | ID: lil-744690

ABSTRACT

Objetivo: Valorar tasa de adherencia y causas de no adherencia a las guías terapéuticas internacionales para la prescripción antibiótica empírica en la neumonía grave en Latinoamérica. Métodos: Encuesta clínica realizada a 36 médicos de Latinoamérica donde se pedía indicar el tratamiento empírico en 2 casos clínicos ficticios de pacientes con infección respiratoria grave: neumonía adquirida en la comunidad y neumonía nosocomial. Resultados: En el caso de la neumonía comunitaria el tratamiento fue adecuado en el 30,6% de las prescripciones. Las causas de no adherencia fueron monoterapia (16,0%), cobertura no indicada para multirresistentes (4,0%) y empleo de antibióticos con espectro inadecuado (44,0%). En el caso de la neumonía nosocomial el cumplimiento de las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 2,8%. Las causas de falta de adherencia fueron monoterapia (14,3%) y la falta de doble tratamiento antibiótico frente a Pseudomonas aeruginosa (85,7%). En caso de considerar correcta la monoterapia con actividad frente a P. aeruginosa, el tratamiento sería adecuado en el 100% de los casos. Conclusión: En la neumonía comunitaria la adherencia a las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 30,6%; la causa más frecuente de incumplimiento fue el uso de monoterapia. La adherencia en el caso de la neumonía nosocomial fue del 2,8% y la causa más importante de incumplimiento fue la falta de doble tratamiento frente a P. aeruginosa, considerando adecuada monoterapia con actividad frente a P. aeruginosa la adherencia sería del 100%. .


Objective: To assess the adherence to Infectious Disease Society of America/American Thoracic Society guidelines and the causes of lack of adherence during empirical antibiotic prescription in severe pneumonia in Latin America. Methods: A clinical questionnaire was submitted to 36 physicians from Latin America; they were asked to indicate the empirical treatment in two fictitious cases of severe respiratory infection: community-acquired pneumonia and nosocomial pneumonia. Results: In the case of communityacquired pneumonia, 11 prescriptions of 36 (30.6%) were compliant with international guidelines. The causes for non-compliant treatment were monotherapy (16.0%), the unnecessary prescription of broad-spectrum antibiotics (40.0%) and the use of non-recommended antibiotics (44.0%). In the case of nosocomial pneumonia, the rate of adherence to the Infectious Disease Society of America/American Thoracic Society guidelines was 2.8% (1 patient of 36). The reasons for lack of compliance were monotherapy (14.3%) and a lack of dual antibiotic coverage against Pseudomonas aeruginosa (85.7%). If monotherapy with an antipseudomonal antibiotic was considered adequate, the antibiotic treatment would be adequate in 100% of the total prescriptions. Conclusion: The compliance rate with the Infectious Disease Society of America/American Thoracic Society guidelines in the community-acquired pneumonia scenario was 30.6%; the most frequent cause of lack of compliance was the indication of monotherapy. In the case of nosocomial pneumonia, the compliance rate with the guidelines was 2.8%, and the most important cause of non-adherence was lack of combined antipseudomonal therapy. If the use of monotherapy with an antipseudomonal antibiotic was considered the correct option, the treatment would be adequate in 100% of the prescriptions. .


Subject(s)
Humans , Pneumonia/drug therapy , Cross Infection/drug therapy , Community-Acquired Infections/drug therapy , Guideline Adherence , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Surveys and Questionnaires , Practice Guidelines as Topic , Latin America , Anti-Bacterial Agents/therapeutic use
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