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1.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 17-26, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1145877

ABSTRACT

Objetivo: verificar a demanda de hemoculturas, aspirados traqueais e uroculturas realizadas no HU-UNIVASF/ EBSERH e a prevalência dos microrganismos identificados no período de janeiro a junho de 2016. Métodos: estudo retrospectivo documental com abordagem quantitativa. Resultados: o setor de microbiologia realizou 488 hemoculturas, 427 uroculturas e 197 aspirados traqueais. A positividade de hemoculturas mostrou-se entre 10,9 à 25,7%, e o percentual de contaminações variou de 6,8 à 14,0%. Os microrganismos mais prevalência nas hemoculturas foram Staphylococcus epidermidis (23,7%), Staphylococcus aureus (19,3%) e Klebisiella pneumoniae (9,6%). Nas uroculturas foram Klebisiella pneumoniae (23,1%), Candida sp. (13,5%) e Escherichia coli (12,5%). Nos aspirados traqueais foram Acinetobacter baumannii (29,2%), Pseudomonas aeruginosa (26,6%) e Staphylococcus aureus (16,2%). Conclusão: a cultura mais solicitada foi hemocultura. A bactéria mais prevalente nas hemoculturas foi Staphylococcus epidermidis, nos aspirados traqueais Acinetobacter baumannii e nas uroculturas Klebisiella pneumoniae


Objective: the study's purpose has been to verify the demand for blood cultures, tracheal aspirates and urine cultures performed at a University Hospital from the Universidade Federal do Vale do São Francisco (HU-UNIVASF/EBSERH), as well as the predominance of microorganisms identified over the period from January to June 2016. Methods: it is a retrospective documentary study with a quantitative approach. Results: the microbiology sector carried out 488 blood cultures, 427 urine cultures and 197 tracheal aspirates. The positivity of blood cultures was between 10.9 and 25.7%, and the percentage of contaminations ranged from 6.8 to 14.0%. The most prevalent microorganisms in blood cultures were Staphylococcus epidermidis (23.7%), Staphylococcus aureus (19.3%) and Klebsiella pneumoniae (9.6%). In urine cultures were Klebsiella pneumoniae (23.1%), Candida sp. (13.5%) and Escherichia coli (12.5%). In tracheal aspirates were Acinetobacter baumannii (29.2%), Pseudomonas aeruginosa (26.6%) and Staphylococcus aureus (16.2%). Conclusion: the most requested culture was blood culture. The most prevalent bacterium in blood cultures was Staphylococcus epidermidis, in tracheal aspirates was Acinetobacter baumannii, and in urine cultures was Klebsiella pneumoniae


Objetivo: el propósito del trabajo es verificar la demanda de hemocultivos, aspirados traqueales y urocultivos realizados en el Hospital Universitário de la Universidade Federal do Vale do São Francisco (HU-UNIVASF/ EBSERH) y la prevalencia de los microorganismos identificados en el período de enero a junio de 2016. Métodos: este trabajo es un estudio retrospectivo documental con abordaje cuantitativo. Resultados: el sector de microbiología realizó 488 hemocultivos, 427 urocultivos y 197 aspirados traqueales. La positividad de hemocultivos se mostró entre el 10,9 al 25,7%, y el porcentaje de contaminaciones varía de 6,8 a 14,0%. Los microorganismos más prevalentes en los hemocultivos fueron Staphylococcus epidermidis (23,7%), Staphylococcus aureus (19,3%) y Klebsiella pneumoniae (9,6%). En los urocultivos fueron Klebisiella pneumoniae (23,1%), Candida sp. (13,5%) y Escherichia coli (12,5%). En los aspirados traqueales fueron Acinetobacter baumannii (29,2%), Pseudomonas aeruginosa (26,6%) y Staphylococcus aureus (16,2%). Conclusión: la cultura más solicitada fue hemocultivo. La bacteria más prevalente en los hemocultivos fue Staphylococcus epidermidis, en los aspirados traqueales, Acinetobacter baumannii y en los urocultivos, Klebisiella pneumoniae


Subject(s)
Urine/microbiology , Cross Infection/microbiology , Cross Infection/epidemiology , Bacteriological Techniques/methods , Blood Culture , Staphylococcus aureus , Staphylococcus epidermidis , Prevalence , Acinetobacter baumannii , Escherichia coli , Hospitals, University , Klebsiella pneumoniae
2.
Rev. epidemiol. controle infecç ; 10(2): 151-157, abr.-jun. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1223692

ABSTRACT

Justificativa e objetivos. Programas de gestão de antimicrobianos (PGA) podem contribuir para otimizar o uso de antimicrobianos em unidades de tratamento intensivo neonatais (UTINEO). O objetivo deste estudo foi mensurar o consumo de antimicrobianos, dentre eles os carbapenêmicos e infecções relacionadas à assistência à saúde (IRAS), especificamente as causadas por bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) em neonatos após a implantação de um PGA. Métodos: Estudo prospectivo descritivo do consumo de antimicrobianos, dentre eles os carbapenêmicos; e das taxas de IRAS em uma UTINEO, durante 1 ano de seguimento. O consumo fo i medido em dias de terapia/1000 pacientes-dia (DOT/1000PD). Resultados: Em setembro de 2017 o PGA foi implementado com os seguintes elementos-chave: auditoria de antibióticos/feedback, restrição de antimicrobianos-alvo, medida do consumo de antimicrobianos e maior rapidez na liberação de resultados de culturas. Entre setembro de 2017 e setembro de 2018 admitimos 308 pacientes, totalizando 2223 pacientes-dia. A mediana de consumo total de antimicrobianos foi de 1580 DOT/1000PD (variação de 1180,7 a 2336,6/mês) sem tendência de aumento e a de carbapenêmicos 12 DOT/1000PD (variação de 0 a 163,2/mês). O consumo de carbapenêmicos foi reduzido entre abril a setembro de 2018 (valor de p =0,07) quando comparado com os primeiros seis meses. Oito IRAS foram registradas, correspondendo a uma densidade de incidência de 3,6/1000 pacientes-dia. Não foram reportadas BGN-CR causando IRAS. Conclusões: O consumo total de antimicrobianos não apresentou aumento ao longo do ano após implantação do PGA. No entanto, houve redução significativa do consumo de carbapenêmicos. Não foram verificadas IRAS por BGN-CR no período do estudo.(AU)


Background and objectives: Antimicrobial stewardship programs (ASPs) could contribute to optimize antimicrobial use within neonatal intensive care units (NICUs). The aim of this study was to measure the antimicrobial consumption, including carbapenems and healthcare-associated infections (HAI), specifically infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in neonates, after implementation of an ASP. Methods: A prospective descriptive study of antimicrobial and carbapenem consumption; and healthcare-associated rate in a NICU, during a one-year follow-up. The consumption was measured in days of therapy /1000 patients-days(DOT/1000PD). Results: In September 2017, the ASP was implemented, with the following core components: antibiotic audit and feedback, restriction of target antimicrobials, measure of antimicrobial consumption and improvement of results from microbiologic laboratory. Between September 2017 and September 2018, we admitted 308 patients, totalizing 2223 patient-days. The median of total antimicrobial consumption was 1580 DOT/1000PD (range from 1180.7 to 2336.6/month and of carbapenems 12 DOT/1000PD (range from 0 to 162.3/month). The carbapenem consumption was reduced between April and September of 2018 (p value=0.07) when we compared the first six months of the study. Eight HAI were detected, corresponding to density of incidence of 3.6/1000 patient-days. No HAI due to CR-GNB was reported. Conclusion: The total antimicrobial consumption did not increase during all the year after the ASP implantation. Although there was a significant reduction of carbapenem consumption. Carbapenem-resistant bacteria was not found in NICU causing HAI.(AU)


Justificación y objetivos: Los programas de optimizatión de uso de antimicrobianos (POA) podrían contribuir a optimizar el uso de antimicrobianos dentro de las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue medir el consumo de antimicrobianos incluidos los carbapenems y las infecciones asociadas a la atención de la salud (IAAs), especificamente las infecciones causadas por bacterias Gram negativas resistentes a carbapenems (CR-GNB) en neonatos, después de la implementación de un POA. Métodos: Un estudio descriptivo prospectivo del consumo de antimicrobianos y carbapenems; y la tasa de IAAs en una UCIN durante un año de seguimiento. El consumo se midió en días de terapia (DOT) / 1000 pacientes-días. Resultados: En septiembre de 2017, se implementó el POA con los siguientes componentes principales: auditoría y retroalimentación de antibióticos, restricción de antimicrobianos objetivo, medición del consumo de antimicrobianos y mejora de los resultados del laboratorio microbiológico. Entre septiembre de 2017 y septiembre de 2018, admitimos 308 pacientes, totalizando 2223 días-paciente. La mediana del consumo total de antimicrobianos fue de 1580 DOT / 1000PD (rango de 1180.7 a 2336.6 / mes y de carbapenems 12 (rango de 0 a 162.3 / mes). El consumo de carbapenem se redujo entre abril y septiembre de 2018 (valor p = 0.07) cuando comparamos los primeros seis meses del estudio, se detectaron ocho IAAs, lo que corresponde a la densidad de incidencia de 3.6 / 1000 días-paciente No se informó ningún IAA debido a CR-GNB. Conclusiones: El consumo total de antimicrobianos no aumentó durante todo el año posterior a la implantación de POA. Aunque hubo una reducción significativa del consumo de carbapenem. No se encontraron bacterias resistentes a carbapenem en la UCIN que causa IAA.(AU)


Subject(s)
Humans , Infant, Newborn , Health Programs and Plans , Intensive Care Units, Neonatal , Cross Infection/microbiology , Delivery of Health Care , Antimicrobial Stewardship , Anti-Infective Agents/therapeutic use , Time Factors , Birth Weight , Carbapenems/therapeutic use , Prospective Studies , Gram-Negative Bacterial Infections/microbiology , Anti-Bacterial Agents/therapeutic use
3.
Rev. Soc. Bras. Med. Trop ; 53: e20180498, 2020. tab
Article in English | LILACS | ID: biblio-1057281

ABSTRACT

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , Cross Infection/microbiology , Pseudomonas aeruginosa/isolation & purification , Microbial Sensitivity Tests , Prevalence , Drug Resistance, Multiple, Bacterial , Intensive Care Units , Anti-Bacterial Agents/pharmacology
4.
Rev. cuba. med. mil ; 48(3): e335, jul.-set. 2019. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126628

ABSTRACT

Introducción: El Acinetobacter spp. se ha convertido en un germen de gran relevancia clínica, resulta un verdadero paradigma de las infecciones nosocomiales multirresistentes. Objetivo: Caracterizar los aislamientos microbiológicos de Acinetobacter spp. en infecciones asociadas a la asistencia sanitaria. Métodos: Estudio descriptivo que incluyó 280 aislamientos de Acinetobacter spp. de las muestras provenientes de pacientes hospitalizados, en el periodo de tres años (del 2016 al 2018) en el Hospital Comandante "Manuel Fajardo Rivero". Las variables del estudio fueron: salas de procedencia del aislamiento, tipo de muestra, factor predictivo, diagnóstico infectológico, susceptibilidad antimicrobiana in vitro y multidrogorresistencia, Resultados: El mayor número de aislamientos de Acinetobacter spp. se obtuvo en la unidad de cuidados intensivos (78,9 por ciento), las secreciones respiratorias fueron las muestras con más aislamientos (58,9 por ciento), la ventilación mecánica resultó el factor predictivo más frecuente (67,9 por ciento) y como diagnóstico infectológico, la neumonía asociada al ventilador (66,8 por ciento). Se encontró un porcentaje elevado de cepas con multidrogorresistencia (73,6 por ciento). Conclusiones: El Acinetobacter spp. se encuentra vinculado a las infecciones asociadas a los servicios de salud, fundamentalmente en los cuidados intensivos. Los antimicrobianos probados evidenciaron altos porcentajes de resistencia, con predominio de las cepas multidrogorresistentes(AU)


Introduction: Acinetobacter spp. has become a germ of great clinical relevance, it is a true paradigm of multiresistant nosocomial infections. Objective: To characterize the microbiological isolates of Acinetobacter spp. in infections associated with health care. Methods: Descriptive study that included 280 isolates of Acinetobacter spp. from the samples of hospitalized patients, in the period of three years (from 2016 to 2018) in the Hospital Comandante "Manuel Fajardo Rivero". The variables of the study were: wards of origin of the isolation, type of sample, predictive factor, infectious diagnosis, antimicrobial susceptibility in vitro and multidrug resistance. Results: The highest number of isolates of Acinetobacter spp. was obtained in the intensive care unit (78.9 percent), the respiratory secretions were the samples with the most isolations (58.9 percent), mechanical ventilation was the most frequent predictor (67.9 percent) and as an infectious diagnosis, ventilator-associated pneumonia (66.8 percent). A high percentage of strains with multidrug resistance (73.6 percent) was found. Conclusions: Acinetobacter spp. is linked to infections associated with health services, mainly in intensive care. The antimicrobials tested showed high percentages of resistance, with a predominance of multidrug resistant strains(AU)


Subject(s)
Acinetobacter Infections/parasitology , Acinetobacter Infections/drug therapy , Cross Infection/microbiology , Bodily Secretions , Epidemiology, Descriptive , Observational Study
5.
Rev. chil. infectol ; 36(4): 433-441, ago. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1042659

ABSTRACT

Resumen Introducción: Las infecciones causadas por enterobacterias productoras de β-talactamasas de espectro extendido (EP-BLEE) tienen implicaciones sobre la morbilidad y mortalidad neonatal. Objetivo: Describir la prevalencia de EP-BLEE en sepsis neonatal y los factores asociados. Métodos: Estudio de cohorte prospectivo, desde agosto del 2016 a agosto del 2017. Se incluyeron recién nacidos (RNs) ingresados en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Mediante prueba de difusión de doble disco se indagó la presencia de EP-BLEE y su asociación con características clínicas y demográficas de los RNs. Resultados: Se estudiaron 1.501 RNs hospitalizados, con edad gestacional promedio de 36,3 semanas. Se diagnosticaron 196 eventos de sepsis neonatal, la etiología más frecuente fueron enterobacterias (45,5%); 88,8% demostraron resistencia a ampicilina y más de 42% a cefalosporinas de amplio espectro. El 22,9% presentó fenotipo BLEE positivo. Tener Apgar ≤ 7 a los cinco minutos de vida (OR 4,6; IC 95% 1,47-14,6) y edad gestacional < 37 semanas (OR 5,4; IC 95%1,04-27,7) incrementaron el riesgo. Conclusión: En las enterobacterias causantes de sepsis neonatal, 22,9% son EP-BLEE; la infección es más probable en pacientes con Apgar ≤ 7 a los cinco minutos de vida y en prematuros.


Background: Infections caused by extended-spectrum beta-lactamases enterobacteria (ESBL-EP) have implications for neonatal morbidity and mortality. Aim: To describe the prevalence of ESBL-EP in neonatal sepsis and associated factors. Methods: A prospective cohort study was conducted from August 2016 to August 2017; newborn babies (NB) hospitalized in the Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" were included. The ESBL-EP were investigated by double-disk synergy test and its association with clinical and demographic characteristics of the NB. Results. A total of 1,501 hospitalized NB were studied, with an average gestational age of 36.3 weeks. They were diagnosed 196 neonatal sepsis events, the most frequent etiologies were enterobacteria (45.5%). Resistance to ampicilin was found in 88.8% and to broad spectrum cephalosporins in more than 42% of the strains; 22.9% of them were ESBL phenotype. Apgar ≤ 7 at five minutes of life (OR 4.6; 95% CI 1.47-14.6) and gestational age < 37 weeks (OR 5.4; 95% CI 1.04-27.) increase the risk. Conclusion: In enterobacteria that cause neonatal sepsis, 22.9% were EP-ESBL; infection was more likely in patients with Apgar ≤ 7 at five minutes of age and in preterm infants.


Subject(s)
Humans , Male , Female , Infant, Newborn , Child , Adolescent , Adult , Middle Aged , Young Adult , beta-Lactamases/biosynthesis , Cross Infection/microbiology , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/microbiology , Neonatal Sepsis/microbiology , Anti-Bacterial Agents/pharmacology , Intensive Care Units, Neonatal , Microbial Sensitivity Tests , Prevalence , Prospective Studies , Risk Factors , Enterobacteriaceae/classification
6.
Rev. pediatr. electrón ; 16(2): 3-7, ago. 2019.
Article in Spanish | LILACS | ID: biblio-1021327

ABSTRACT

Los pacientes inmunocomprometidos presentan un riesgo aumentado de colonización e infecciones por microorganismos multirresistentes (MOR), entre ellos Enterococcus spp resistentes a vancomicina (ERV) y bacterias productoras de betalactamasas de espectro extendido (BLEE), las cuales son causa importante de morbimortalidad. OBJETIVO: Describir la prevalencia de MOR en Servicio de Oncología del Hospital Roberto del Río. MÉTODO: Se realizó un estudio descriptivo retrospectivo de los niños hospitalizados en el servicio de oncología desde enero a diciembre del 2016 a los cuales se les realizó vigilancia de portación de ERV y BLEE. RESULTADOS: De los 97 pacientes hospitalizados, se identificó un 8% de portación de ERV, un 13,7% de BLEE y un 6,8% presentó portación de ambos microorganismos. DISCUSIÓN: Entre enero 2012 a diciembre del 2013 se observó en nuestro centro que un 52% de los pacientes hospitalizados en oncología estaban colonizados por ERV, la disminución significativa de la portación podría deberse a la mejor adherencia de normas de prevención de infecciones asociadas a la atención en salud (IAAS), programa de uso racional de antimicrobianos y a la nueva infraestructura del servicio.


The inmunosupressed patients are at increased risk of colonization and infection with vancomycin resistant Enterococci (VRE) and extended- spectrum b-lactamase producing Enterobacteriaceae (ESBL), which can cause substantial morbidity and mortality. OBJECTIVE: Describe the prevalence of VRE and ESBL in the Oncology Unit of Roberto del Río Hospital. METHODS: Descriptive and retrospective study of hospitalized children since January to December 2016 in the Oncology Unit, that underwent VRE and ESBL colonization surveillance. RESULTS: From the 97 hospitalized patients, there were 8% of VRE colonization, 13.7% of ESBL and 6.8% of colonization from both microorganism. DISCUSSION: Between January 2012 and December 2013, we observed that 52% of hospitalized patients in the Oncology Unit were colonized by VRE. The significant decrease in colonization may be due to better fulfillment of healthcare-associated infections (HAI) normative, antibiotics stewardship and new infraestructure of our unit.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , beta-Lactamases/metabolism , Cross Infection/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/enzymology , Cross Infection/microbiology , Cross Infection/prevention & control , Prevalence , Retrospective Studies , Oncology Service, Hospital , Infection Control , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/prevention & control , Hospitals, Pediatric
7.
Rev. chil. infectol ; 36(2): 145-166, abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1003664

ABSTRACT

Resumen El enfrentamiento del diagnóstico diferencial y etiológico de las enfermedades infecciosas de los pacientes con cáncer, incluyendo los receptores de trasplante de precursores hematopoyéticos (TPH), debe corresponder a una decisión informada, oportuna y que repercuta directamente en una conducta médica que determine una mejor sobrevida y calidad de vida de los pacientes. El objetivo de este trabajo fue aportar en el manejo de estos pacientes desarrollando una herramienta útil al médico clínico para tomar estas decisiones. Para ello se agruparon las infecciones por sistemas comprometidos diferenciando los posibles agentes etiológicos en bacterias, virus, hongos y parásitos, explicitando los exámenes diagnósticos más relevantes, mencionando la o las técnicas recomendadas, junto con el tipo de muestra óptima para su adecuado procesamiento. De manera adicional, se incorporó el ítem "nivel de requerimiento" para sugerir lo que, a juicio de los autores y la evidencia existente, debe estar presente obligatoriamente en el centro o puede ser derivable a otro laboratorio.


The confrontation of the differential and etiological diagnosis of the infectious diseases of cancer patients, including hematopoietic stem cells transplant (HSCT) recipients, must correspond to an informed, timely decision that directly affects medical behavior that determines a better survival and quality of life for patients. The main goal of this work was to contribute to the management of these patients developing a useful tool for the clinician to make these decisions. For that, infections were grouped by compromised systems, differentiating the possible etiological agents in bacteria, viruses, fungi and parasites, highlighting the relevant diagnostic tests, mentioning the recommended techniques together with the optimal sample type for proper processing. In addition, under each group of techniques we added the item "level of requirement" to suggest what, in the opinion of the authors and the existing evidence, must be mandatory to have at local level or can be derivable to another laboratory.


Subject(s)
Humans , Laboratories, Hospital/standards , Cross Infection/diagnosis , Cross Infection/microbiology , Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms/complications , Biopsy/standards , Cross Infection/therapy , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapy
8.
Rev. chil. infectol ; 36(2): 126-138, abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1003663

ABSTRACT

Resumen El ambiente hospitalario es una fuente potencial de exposición a patógenos como bacterias, hongos y parásitos, que pueden provocar infecciones en pacientes con cáncer incluyendo receptores de trasplante de precursores hematopoyéticos. Para aminorar este riesgo, se deben tener en cuenta los elementos de diseño, construcción y emplazamiento del área de atención de pacientes. Se entregan recomendaciones para proveer ambientes seguros, incluyendo características y uso de ambiente protegido, la definición de procesos críticos, equipos clínicos destinados a la atención de pacientes, sugerencias de ámbitos a supervisar y aspectos relativos a la calidad microbiológica del aire y agua.


The hospital environment is a potential source of exposure to pathogens such as bacteria, fungi and parasites that can cause infections in patients with cancer including transplanted hematopoietic precursors. To mitigate this risk, the design, construction and location elements of the patient care area must be taken into account. Recommendations are given to provide safe environments, including aspects related to characteristics and use of a protected environment, the definition of critical processes, clinical teams dedicated to the care of patients, suggestions of areas to be monitored, the microbiological quality of air and water.


Subject(s)
Humans , Cross Infection/microbiology , Cross Infection/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Equipment and Supplies, Hospital/microbiology , Hospital Design and Construction/methods , Neoplasms/complications , Water Microbiology , Risk Factors , Infection Control/methods , Risk Assessment , Air Microbiology , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapy
9.
Braz. j. infect. dis ; 23(2): 139-142, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039225

ABSTRACT

ABSTRACT Introduction: This study aimed to characterize Staphylococcus aureus isolates from bloodstream infections in patients attending a teaching hospital, between 2011 and 2015. Methods: The minimum inhibitory concentration for daptomycin, linezolid, oxacillin, teicoplanin, vancomycin, and trimethoprim/sulfamethoxazole was accessed by broth microdilution. SCCmec type and clonal profile were determined by molecular tests. Vancomycin heteroresistance was evaluated using screening tests and by population analysis profile/area under the curve. Results: Among 200 S. aureus isolates, 55 (27.5%) were MRSA, carrying SCCmec II (45.5%) or IV (54.5%). The most frequent MRSA lineages were USA100 (ST5-II) (45.5%) and USA800 (ST5-IV) (30.9%). Six isolates were confirmed as vancomycin heteroresistant, showing area under the curve ratio 1.1, 1.2 or 1.3 (four USA100, one USA800 and one USA1100 isolates). Conclusions: Daptomycin and vancomycin non-susceptible MRSA clonal lineages were found in bloodstream infections over five years, highlighting the importance of continuous surveillance of multiresistant bacteria in hospitals.


Subject(s)
Humans , Vancomycin/pharmacology , Bacteremia/microbiology , Daptomycin/pharmacology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Anti-Bacterial Agents/pharmacology , Staphylococcal Infections/microbiology , Brazil , Microbial Sensitivity Tests , Cross Infection/microbiology , Hospitals, Teaching
10.
Braz. j. infect. dis ; 23(2): 134-138, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039223

ABSTRACT

ABSTRACT This study characterized 30 MRSA isolates from intensive care unit (ICU) environment and equipment surfaces and healthy children. The SCCmec types I, IVa and V were detected in HA-MRSA isolates while CA-MRSA showed the SCCmec type IVa and V. Most isolates were classified as agr group II. All isolates presented the sei gene, and only HA-MRSA were positive for etb e tst genes. Three genotypes were related to Pediatric (ST5/SCCmecIV) and Berlin (ST45/SCCmecIV) clones. The present study showed molecular similarity between CA- and HA-MRSA isolates in hospital and community settings in a Brazilian region.


Subject(s)
Humans , Cross Infection/microbiology , Community-Acquired Infections/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/genetics , Intensive Care Units/statistics & numerical data , Staphylococcal Infections/genetics , Staphylococcal Infections/microbiology , Brazil , Virulence Factors/isolation & purification , Virulence Factors/genetics , Equipment and Supplies, Hospital/microbiology , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Genotype
11.
Rev. Soc. Bras. Med. Trop ; 52: e20190205, 2019. tab, graf
Article in English | LILACS | ID: biblio-1020444

ABSTRACT

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cross Infection/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Drug Resistance, Multiple, Bacterial , Intensive Care Units, Neonatal , Cross-Sectional Studies , Gram-Positive Bacterial Infections/classification , Gram-Negative Bacterial Infections/classification , Epidemiological Monitoring
12.
Braz. j. infect. dis ; 22(6): 455-461, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-984019

ABSTRACT

ABSTRACT Background: The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia). Objective: Evaluate the effect of time to CVC removal, early (within 48 h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality. Methods: Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48 h (first analysis) or at any time (second analysis). Results: A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1-28) but was six days (range 3-28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066-1.158), removal at any time (OR 0.079, 95% CI 0.021-0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133-0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071-1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103-0.590) retained significance. Conclusions: The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Catheterization, Central Venous/adverse effects , Cross Infection/mortality , Hospital Mortality , Device Removal , Candidemia/mortality , Time Factors , Catheterization, Central Venous/statistics & numerical data , Cross Infection/microbiology , Retrospective Studies , Risk Factors , APACHE , Candidemia/microbiology
13.
Rev. Soc. Bras. Med. Trop ; 51(5): 603-609, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-957466

ABSTRACT

Abstract INTRODUCTION: The behavior of methicillin-resistant Staphylococcus aureus (MRSA) isolated from central venous catheter-related infection was evaluated to determine its biofilm potential, antimicrobial resistance, and adhesion genes. METHODS: A total of 1,156 central venous catheters (CVC) were evaluated to screen for pathogens. Antimicrobial sensitivity, biofilm formation potential, and molecular analysis of MRSA were examined following standard guidelines. RESULTS: Of the 1,156 samples, 882 (76%) were colonized by bacteria or candida. Among the infected patients, 69% were male and 36% were female with median age of 32 years. Staphylococcus aureus infected 39% (344/882) of CVCs in patients. Of the 59% (208/344) of patients with MRSA, 57% had community acquired MRSA and 43% had hospital acquired MRSA. Linezolid and vancomycin killed 100% of MRSA; resistance levels to fusidic acid, doxycycline, clindamycin, azithromycin, amikacin, trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ofloxacin were 21%, 42%, 66%, 68%, 72%, 85%, 95%, 97%, and 98% respectively. Strong biofilm was produced by 23% of samples, moderate by 27%, and weak by 50% of MRSA. The presence of adhesion genes, sdrC and sdrD (90%), eno (87%), fnbA (80%), clfA and sdrE (67%), fnbB, sdrD (61%), and cna (51%), in most MRSA samples suggested that the adhesion genes are associated with biofilm synthesis. CONCLUSIONS: The superbug MRSA is a major cause of CVC-related infection. Antibiotic resistance to major classes of antibiotics and biofilm formation potential enhanced superbug MRSA virulence, leading to complicated infection. MRSA causes infection in hospitals, communities, and livestock.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Staphylococcal Infections/microbiology , Cross Infection/microbiology , Community-Acquired Infections/microbiology , Biofilms/growth & development , Methicillin-Resistant Staphylococcus aureus/physiology , Catheter-Related Infections/microbiology , Anti-Bacterial Agents/pharmacology , Bacterial Adhesion/genetics , Microbial Sensitivity Tests , Biofilms/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Genes, Bacterial/genetics , Middle Aged
14.
Rev. Soc. Bras. Med. Trop ; 51(5): 709-711, Sept.-Oct. 2018. graf
Article in English | LILACS | ID: biblio-957463

ABSTRACT

Abstract Ralstonia mannitolilytica, a Gram-negative bacterium, is rarely isolated in clinical laboratories. It has been associated with outbreaks due to its ability to survive in liquid media and hospital devices. We describe three cases of bacteremia caused by R. mannitolilytica in a neonatal intensive care unit in Curitiba, Southern Brazil. All isolates presented the same PFGE profile. The common source of infection was undetected in surveillance cultures for the outbreak survey. All patients received antimicrobial treatment and were discharged from the maternity. Due to the characteristics of the microorganism, clinicians and microbiologists should pay attention to the emergence of Ralstonia spp. infections.


Subject(s)
Humans , Male , Female , Infant, Newborn , Intensive Care Units, Neonatal , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Bacteremia/microbiology , Ralstonia/isolation & purification , Brazil , Cross Infection/diagnosis , Gram-Negative Bacterial Infections/diagnosis , Bacteremia/diagnosis
15.
Braz. j. infect. dis ; 22(5): 438-441, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-1039218

ABSTRACT

ABSTRACT Acinetobacter baumannii is one of the most frequent Gram-negative opportunistic pathogens associated with hospital-acquired infection worldwide. We briefly describe A. baumannii isolates that were recovered from surrounding ICU bed surfaces, exhibiting multidrug resistance phenotype and belonging to some widely spread clonal complexes of clinical A. baumannii isolates.


Subject(s)
Beds/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Acinetobacter baumannii/isolation & purification , Intensive Care Units , Bacteria/isolation & purification , Bacteria/drug effects , Brazil , Microbial Sensitivity Tests , Cross Infection/microbiology , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Tertiary Care Centers , Genes, Bacterial
16.
Braz. j. infect. dis ; 22(5): 424-432, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974235

ABSTRACT

ABSTRACT Introduction: Nontyphoidal Salmonella serotypes are the main cause of human food-borne infection, including several hospitalization cases in the developing countries. Aim: To detect the main serotypes and to characterize the antibiotic resistance of human non-enteric and enteric nontyphoidal Salmonella from clinical isolates in Brazil. Methods: Salmonella serotypes were identified by microbiological and molecular methods. Susceptibility testing to antibiotics was performed by agar disk diffusion. Real-time PCRs were carried out for the detection of the genus Salmonella as well as serotypes Typhimurium and Enteritidis. Results: A total of 307 nontyphoidal Salmonella were isolated from 289 different patients in a reference laboratory (LACEN-RS) from Southern Brazil in a six-year period (2010-2015). There were 45 isolates from emerging cases and 244 from sporadic cases in hospitalized patients. Non-enteric isolates were detected in 42.6% of the patients from sources such as urine, blood and other clinical fluids. Serological and PCR-specific tests demonstrated that Typhimurium (48.4%) and Enteritidis (18.3%) were the most frequent serotypes. Typhimurium isolates were generally resistant to three or more antibiotic classes, while Enteritidis isolates to one or two classes. Typhimurium was the most frequent serotype in all samples (48.4%), mainly among the hospitalized patients (55.6%), and presented the highest rates of multidrug resistance (59.3% of the isolates of this serotype). Further, the prevalence of this serotype increased along the years of the study in comparison to other nontyphoidal Salmonella serotypes. Conclusion: Greater public health attention should be given to prevent salmonellosis in the community and in hospital settings to reduce the rates of Typhimurium strains with multidrug resistance.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Salmonella Infections/microbiology , Salmonella Infections/epidemiology , Salmonella typhimurium/drug effects , Drug Resistance, Multiple, Bacterial , Hospitalization/statistics & numerical data , Salmonella enteritidis/isolation & purification , Salmonella enteritidis/drug effects , Salmonella typhimurium/isolation & purification , Time Factors , Brazil/epidemiology , Microbial Sensitivity Tests , Serotyping , Cross Infection/microbiology , Cross Infection/epidemiology , Prevalence , Real-Time Polymerase Chain Reaction , Serogroup , Anti-Bacterial Agents/pharmacology
17.
Braz. j. microbiol ; 49(3): 552-558, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-951796

ABSTRACT

Abstract Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.


Subject(s)
Humans , Postoperative Complications/microbiology , Bacteria/drug effects , Bacterial Infections/microbiology , Cross Infection/microbiology , Anti-Bacterial Agents/administration & dosage , Postoperative Complications/prevention & control , Bacteria/isolation & purification , Bacteria/growth & development , Bacterial Infections/prevention & control , Preoperative Care , Drug Resistance , Microbial Sensitivity Tests , China , Cross Infection/prevention & control , Antibiotic Prophylaxis
18.
Rev. Soc. Bras. Med. Trop ; 51(4): 415-420, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-957444

ABSTRACT

Abstract Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings.


Subject(s)
Humans , Pseudomonas aeruginosa , Pseudomonas Infections/mortality , Cross Infection/mortality , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/therapeutic use , Pseudomonas Infections/drug therapy , Cross Infection/microbiology
19.
Braz. j. infect. dis ; 22(4): 338-344, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-974224

ABSTRACT

ABSTRACT Introduction Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections (HAI) in neonates admitted in neonatal intensive care units (NICUs). Methods We did a systematic review using PRISMA methodology to identify the main etiological agents in Brazilian NICUs. Eligible studies published without period restriction were identified in PUBMED, SCIELO, LILACS and DOAJ. Studies were included if they were conducted in neonates hospitalized at NICU. Studies done in outpatient care, neonates outside NICU, emergency department, primary care, long-term care facilities or a combination of these were excluded. Results We identified 6384 articles in the initial search and four papers met the inclusion criteria. In all studies included, rates of device-associated infections were described, including VAP rates. The VAP incidence density, in exclusively Brazilian NICU, ranged from 3.2 to 9.2 per 1000 ventilator-days. Pneumonia was described as the main HAI in NICU in one article, as the second type of HAI in two other articles and as the fourth type of HAI in the last one. The main pathogens causing all HAI types were described in three of four articles, but, none of the articles reported which pathogens were related or associated to VAP. Conclusion Etiological agents causing VAP in Brazilian NICUs are, until the present time, not known.


Subject(s)
Humans , Infant, Newborn , Intensive Care Units, Neonatal/statistics & numerical data , Cross Infection/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Brazil/epidemiology , Randomized Controlled Trials as Topic , Cross Infection/microbiology , Incidence , Publication Bias , Pneumonia, Ventilator-Associated/microbiology
20.
Rev. Assoc. Med. Bras. (1992) ; 64(8): 736-742, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-976843

ABSTRACT

SUMMARY INTRODUCTION Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days. METHODS All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology where sedation was based as analgesic the opioid remifentanil for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Data analysis was performed using the statistical package Stata version 7.0. RESULTS The patients admitted to the Post-Surgical Critical Care Unit (PCU) during study were 1789 and the population eligible was comprised of 102 patients. 56.86% of patients suffered IACS. The most frequent IACS was pneumonia associated with mechanical ventilation (30.96 per 1000 days of mechanical ventilation), Pseudomonas aeruginosa being the most frequently isolated germ. The germs with the greatest involvement in multiple drug resistance (MDROs) were enterobacteria, mainly Klebsiella pneumoniae resistant to extended-spectrum beta-lactamases (ESBL). CONCLUSIONS Pneumonia associated with mechanical ventilation is the most prevalent HAI and Pseudomonas aeruginosa is the main etiological agent. The groups of antibiotics most frequently used were cephalosporin and aminoglycosides. It is necessary to implement the prevention strategies of the different HAI, since most of them are avoidable.


RESUMO INTRODUCCIÓN Las infecciones asociadas a cuidados de salud (IACS) constituyen la complicación más frecuente de los pacientes hospitalizados. El objetivo de este estudio es describir las características clínicas y epidemiológicas de los pacientes críticos postquirúrgicos con diagnóstico de infección asociada a cuidados de salud, tras una pauta de sedoanalegia de al menos 4 días. MÉTODOS Se seleccionaron de manera consecutiva todos los pacientes mayores de 18 años con un ingreso en la Unidad de Reanimación Postquirúrgica (URP) superior a 4 días. La población de estudio fue aquella afectada por patología quirúrgica de cualquier origen donde la sedación se basó en cualquier hipnótico y como analgésico el opioide remifentanilo durante al menos 96 horas en perfusión continua. Se excluyeron los pacientes que fallecieron durante su ingreso en la unidad y aquellos pacientes con analgesia combinada (bloqueos periféricos o neuroaxiales). El análisis de los datos se realizó con paquete estadístico Stata versión 7.0. RESULTADOS El número de pacientes que ingresaron en la URP durante el periodo de estudio fueron de 1789. Tras aplicar los criterios de inclusión y exclusión, la población elegible quedó constituida por 102 pacientes. Un 56,86% de pacientes padecieron IACS. La IACS más frecuente fue la neumonía asociada a ventilación mecánica (30,96 por 1000 días de ventilación mecánica) siendo Pseudomona aeruginosa el germen más frecuentemente aislado. Los gérmenes con mayor implicación en las multirresistencias (MDROs) fueron las enterobacterias, principalmente Klebsiella pneumoniae resistente a betalactamasas de espectro extendido (BLEE). CONCLUSIONES La neumonía asociada a ventilación mecánica es la IACS más prevalente y Pseudomona aeruginosa es el principal agente etiológico. Los grupos de antibióticos más frecuentemente empleados fueron cefalosporinas y aminoglucósidos. Es necesario implementar las estrategias de prevención de las distintas IACS, ya que la mayoría de ellas son evitables.


Subject(s)
Humans , Male , Female , Aged , Postoperative Complications/epidemiology , Cross Infection/epidemiology , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Postoperative Complications/microbiology , Pseudomonas aeruginosa/isolation & purification , Spain/epidemiology , Time Factors , Midazolam/administration & dosage , Propofol/administration & dosage , Cross Infection/microbiology , Prospective Studies , Risk Factors , Critical Illness , APACHE , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/epidemiology , Deep Sedation/adverse effects , Deep Sedation/methods , Hospitalization/statistics & numerical data , Hypnotics and Sedatives/administration & dosage , Anesthesia, Local/adverse effects , Anesthesia, Local/methods , Klebsiella pneumoniae/isolation & purification , Middle Aged
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