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1.
Rev. inf. cient ; 98(6): 734-743, 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1049190

ABSTRACT

Introducción: en la Unidad de Cuidados Intensivos (UCI) del Hospital Dr. Agostinho Neto no se ha precisado cuálesgérmenes causan la neumonía asociada a la ventilación mecánica. Objetivo: precisar los gérmenes causales de este tipo de neumonía en la citada unidad durante los años 2014-2018. Método: se realizó un estudio observacional, retrospectivo y longitudinal. El universo fueron todos los pacientes con diagnóstico de este tipo de neumonía (N=561), de estos se seleccionó una muestra aleatoria de 200 pacientes. Se estudiaron las siguientes variables: total de pacientes ingresados en la UCI y los que se trataron con ventilación mecánica y tiempo de aplicación de ésta, características de los pacientes (edad, sexo, tipo de paciente y diagnóstico al ingreso), caracterización de esta neumonía (tipo, nivel de gravedad y etiología). Resultados: el 46,8 por ciento de los pacientes que se trató con ventilación mecánica presentó este tipo de neumonía, y de estos el 94,0 por ciento presentó una neumonía detipo tardía. Su edad fue de 56,1 ± 12,4 años y la mayoría fueron varones (n=59). El 65,5 por ciento presentó una enfermedad clínica, y la más común fue la enfermedad cerebrovascular (24,5 por ciento). El 73,5 por ciento se ventiló por más de cinco días. El principal germen causal fue la Klebsiella (24,5 por ciento). Conclusión: la Klebsiella y el Streptococcus pneumoniae son los gérmenes causales más comunes de esta neumonía y esta fue más común en los pacientes con formas clínicas de enfermedad cerebrovascular(AU)


Introduction: in the intensive care unit of the Dr. Agostinho Neto Hospital it has not been specified which germs cause pneumonia associated with mechanical ventilation. Objective: to specify the causal germs of this type of pneumonia in the aforementioned unit during the years 2014-2018. Method: an observational, retrospective and longitudinal study was carried out. The universe was all patients diagnosed with this type of pneumonia (N=561), from these a random sample of 200 patients was selected. The following variables were studied: total of patients admitted to the ICU and those treated with mechanical ventilation and its application time, characteristics of the patients (age, sex, type of patient and diagnosis at admission), characterization of this pneumonia (type, severity level and etiology). Results: 46.8 percent of the patients who were treated with echanical ventilation presented this type of pneumonia, and of these 94.0 percent presented late pneumonia. Their age was 56.1 ± 12.4 years and the majority were male (n=59). 65.5 percent presented a clinical disease, and the most common was cerebrovascular disease (24.5 percent). 73.5 percent was ventilated for more than five days. The main causal germ was Klebsiella (24.5 percent). Conclusion: Klebsiella and Streptococcus pneumoneae are the most common causative germs of this pneumonia and this was more common in patients with clinical forms of cerebrovascular disease(AU)


Introdução: na unidade de terapia intensiva do Hospital Dr. Agostinho Neto no foi especificado quais germes causam pneumonia associada à ventilação mecânica. Objetivo: especificar os germes causais desse tipo de pneumonia na unidade citada nos anos de 2014 a 2018. Método: estudo observacional, retrospectivo e longitudinal. O universo foi constituído por todos os pacientes diagnosticados com esse tipo de pneumonia (N=561), dos quais foi selecionada uma amostra aleatória de 200 pacientes. Foram estudadas as seguintes variáveis: total de pacientes admitidos na UTI e tratados com ventilação mecânica e seu tempo de aplicação, características dos pacientes (idade, sexo, tipo de paciente e diagnóstico na admissão), caracterização dessa pneumonia (tipo, nível de gravidade e etiologia). Resultados: 46,8 por cento dos pacientes tratados com ventilação mecânica apresentaram esse tipo de pneumonia e desses 94,0 por cento apresentaram pneumonia tardia. A idade era de 56,1 ± 12,4 anos e a maioria era do sexo masculino (n=59). 65,5 por cento apresentaram doença clínica e a mais comum foi doença cerebrovascular (24,5 por cento). 73,5 por cento foram ventilados por mais de cinco dias. O principal germe causal foi Klebsiella (24,5 por cento). Conclusão: Klebsiella e streptococcus pneumoneae são os germes causadores mais comuns dessa pneumonia, sendo mais comum em pacientes com formas clínicas de doença cerebrovascular(AU)


Subject(s)
Pneumonia, Ventilator-Associated/complications , Pneumonia, Ventilator-Associated/etiology , Pneumonia, Ventilator-Associated/microbiology
2.
Rev. méd. Maule ; 33(2): 13-19, sept. 2018. tab
Article in Spanish | LILACS | ID: biblio-1292502

ABSTRACT

INTRODUCTION: Ventilator-associated pneumonia is the sixth nosocomial infection most frequent in Chile. Considering the high mortality associated in this infection, it is important to know the local agents and their respective resistances and susceptibilities to choose and appropriate management. OBJECTIVE: Describe the resistance and susceptibilities to antibiotics of the most frequent microorganism in ventilator-associated pneumonia in the Intensive Care Unit at Hospital Regional de Talca. METHODS: We studied the resistance and susceptibility to antibiotics to each organism isolated in patients with ventilator-associated pneumonia in the Intensive Care Unit at Hospital Regional de Talca since 2013 to 2016, according to the reports of the Cross Infection Unit at this establishment. OUTCOMES: We collected 59 cases and there were 29 cases of them with one microorganism. The highest incidence of ventilator-associated pneumonia was in 2014, while the lowest was in 2015. The most frequent agents isolated were A. baumannii (32,2%), S. aureus (30,1%), P. aeruginosa (10,75%) and K. pneumoniae (10,75%). In general, we found that the highest resistence to antibiotic was to Ceftriaxone, while the highest susceptibility to antibiotic were to Vancomicine and Tigecicline.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pneumonia, Ventilator-Associated/microbiology , Microbial Sensitivity Tests , Chile , Cross Infection , Retrospective Studies , Patient Selection , Drug Resistance, Bacterial
3.
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
4.
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
5.
Rev. chil. infectol ; 35(5): 547-552, 2018. tab
Article in Spanish | LILACS | ID: biblio-978068

ABSTRACT

Resumen Introducción: La sepsis neonatal nosocomial (SNN) es una entidad frecuente en las unidades de cuidados intensivos, donde causa una gran morbimortalidad. La ubicación más frecuente es bacteriemia, seguido de neumonía asociada a ventilador mecánico y vía urinaria. Objetivo: Conocer la etiología y localización más frecuente de la infección en el SNN. Población, Material y Métodos: Estudio retrospectivo, de prevalencias de enero a diciembre de 2015, realizado en la Unidad de Cuidados Intensivos Neonatal de un hospital de alta complejidad. Fueron incluidos todos los neonatos. Resultados: Se incluyeron 70 pacientes, se analizaron 88 episodios de SNN. La localización más frecuente fue sangre 40% de los casos, seguido de orina y aspirado traqueal en 25% respectivamente. Los microorganismos más frecuentemente aislados fueron Staphylococcus de diferentes tipos, seguido de Acinetobacter baumannii multi-resistente. La afectación del SNC fue de 32%. La mortalidad fue de 34%, elevándose a 50% ante un segundo episodio de SNN. La terapia empírica de elección fue vancomicina y carbapenem, ajustándose a antibiograma. Conclusiones: La infección más frecuente fue la bacteremia, principalmente por Staphylococcus resistentes a meticilina. La afectación del SNC fue elevada, lo mismo que la mortalidad.


Introduction: Nosocomial neonatal sepsis (NNS) is a frequent entity in intensive care units, causing great morbidity and mortality. The most frequent site is blood, followed by lungs and urine. Objective: To know the etiology and most frequent localization of infection in the NNS. Population, Material and Methods: Cross sectional study, from January to December 2015, performed in a teaching hospital. All newborns infants were included. Results: 70 patients were included, 88 episodes of NNS were analyzed. The most frequent localization was bacteremia in 40% of cases, followed by urinary tract infection and VAP in 25% respectively. The bacteria most frequently isolated were staphylococci of different types, followed by multiresistant Acinetobacter. The CNS involvement was 32%. Mortality was 34%, rising up to 50% with a second episode of NNS. The empirical therapy of choice was vancomycin and carbapenem, adjusting to antibiogram. Conclusions: The most frequent infection was bacteremia, mainly by staphylococci resistant to methicillin. CNS involvement was elevated, as well as mortality.


Subject(s)
Humans , Male , Female , Infant, Newborn , Cross Infection/microbiology , Neonatal Sepsis/microbiology , Gram-Negative Aerobic Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Intensive Care Units, Neonatal , Microbial Sensitivity Tests , Retrospective Studies , Gestational Age , Bacteremia/microbiology , Pneumonia, Ventilator-Associated/microbiology , Gram-Negative Aerobic Bacteria/classification , Gram-Negative Aerobic Bacteria/drug effects , Gram-Positive Bacteria/classification , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/pharmacology
6.
Braz. j. med. biol. res ; 51(7): e6830, 2018. tab
Article in English | LILACS | ID: biblio-889117

ABSTRACT

This study aimed to investigate the risk factors related to ventilator-acquired pneumonia (VAP) in aneurysmal subarachnoid hemorrhage (SAH) patients. From January 2011 to December 2015, a single-center retrospective study including 200 SAH patients requiring mechanical ventilation (MV) ≥48 h was performed. The clinical data of these patients were collected and analyzed. The age range of the patients were 41-63 and 72 (36%) were male. The Glasgow coma scale score range was 5-15 and the Simplified Acute Physiology Score II range was 31-52. One hundred and forty-eight (74%) patients had a World Federation of Neurosurgeons (WNFS) score ≥III. Aneurysm was secured with an endovascular coiling procedure in 168 (84%) patients and 94 (47%) patients presented VAP. Male gender (OR=2.25, 95%CI=1.15-4.45), use of mannitol (OR=3.02, 95%CI=1.53-5.94) and enteral feeding above 20 kcal·kg−1·day−1 (OR=2.90, 95%CI=1.26-6.67) after day 7 were independent factors for VAP. Patients with early-onset VAP had a longer duration of sedation (P=0.03), MV (P=0.001) and ICU length of stay (P=0.003) and a worse Glasgow Outcome Scale score (P<0.001), but did not have a higher death rate.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Subarachnoid Hemorrhage/complications , Pneumonia, Ventilator-Associated/etiology , Subarachnoid Hemorrhage/therapy , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Pneumonia, Ventilator-Associated/microbiology
7.
Rev. bras. ter. intensiva ; 29(3): 310-316, jul.-set. 2017. tab
Article in Portuguese | LILACS | ID: biblio-899522

ABSTRACT

RESUMO Objetivo: Avaliar fenotipicamente a produção de biofilme por isolados clínicos de Pseudomonas aeruginosa de pacientes com pneumonia associada à ventilação mecânica. Métodos: Foram analisados 20 isolados clínicos de P. aeruginosa, sendo 19 provenientes de amostras clínicas de aspirado traqueal e uma de lavado broncoalveolar. A avaliação da capacidade de P. aeruginosa em produzir biofilme foi verificada por duas técnicas, sendo uma qualitativa e outra quantitativa. Resultados: A técnica qualitativa mostrou que apenas 15% dos isolados foram considerados produtores de biofilme, enquanto que a quantitativa demonstrou que 75% dos isolados foram produtores de biofilme. Os isolados produtores de biofilme apresentaram o seguinte perfil de suscetibilidade: 53,3% eram multidroga-resistentes e 46,7% eram multidroga-sensíveis. Conclusão: A técnica quantitativa foi mais eficaz para detecção da produção de biofilme em comparação com a qualitativa. Para a população bacteriana analisada, a produção de biofilme independeu do perfil de suscetibilidade das bactérias, demonstrando que a falha terapêutica pode estar relacionada com a produção de biofilme, por impedir a destruição das bactérias presentes nesta estrutura, ocasionando complicações da pneumonia associada à ventilação mecânica, incluindo infecções extrapulmonares, e dificultando o tratamento da infecção.


ABSTRACT Objective: To phenotypically evaluate biofilm production by Pseudomonas aeruginosa clinically isolated from patients with ventilator-associated pneumonia. Methods: Twenty clinical isolates of P. aeruginosa were analyzed, 19 of which were from clinical samples of tracheal aspirate, and one was from a bronchoalveolar lavage sample. The evaluation of the capacity of P. aeruginosa to produce biofilm was verified using two techniques, one qualitative and the other quantitative. Results: The qualitative technique showed that only 15% of the isolates were considered biofilm producers, while the quantitative technique showed that 75% of the isolates were biofilm producers. The biofilm isolates presented the following susceptibility profile: 53.3% were multidrug-resistant, and 46.7% were multidrug-sensitive. Conclusion: The quantitative technique was more effective than the qualitative technique for the detection of biofilm production. For the bacterial population analyzed, biofilm production was independent of the susceptibility profile of the bacteria, demonstrating that the therapeutic failure could be related to biofilm production, as it prevented the destruction of the bacteria present in this structure, causing complications of pneumonia associated with mechanical ventilation, including extrapulmonary infections, and making it difficult to treat the infection.


Subject(s)
Humans , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/epidemiology , Biofilms , Pneumonia, Ventilator-Associated/microbiology , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , Respiration, Artificial , Bronchoalveolar Lavage Fluid/microbiology , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacology
8.
Braz. j. infect. dis ; 21(1): 1-6, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-839191

ABSTRACT

Abstract Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carbapenems/therapeutic use , Drug Resistance, Bacterial , Enterobacteriaceae Infections/mortality , Pneumonia, Ventilator-Associated/mortality , Anti-Bacterial Agents/therapeutic use , Time Factors , Logistic Models , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Treatment Outcome , Hospital Mortality , Statistics, Nonparametric , Enterobacter aerogenes/drug effects , Drug Therapy, Combination/mortality , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/drug therapy , Klebsiella pneumoniae/drug effects
9.
Braz. oral res. (Online) ; 31: e38, 2017. tab
Article in English | LILACS | ID: biblio-839532

ABSTRACT

Abstract The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.


Subject(s)
Humans , Male , Female , Middle Aged , Bacteria/isolation & purification , Biofilms , Mouth/microbiology , Pneumonia, Ventilator-Associated/microbiology , Trachea/microbiology , Ventilators, Mechanical/microbiology , Candida albicans/isolation & purification , Dental Plaque/microbiology , Equipment Contamination , Intensive Care Units , Intubation, Intratracheal/adverse effects , Longitudinal Studies , Microbial Sensitivity Tests , Pneumonia, Aspiration/microbiology , Respiration, Artificial/adverse effects , Time Factors
10.
Rev. bras. enferm ; 69(6): 1108-1114, nov.-dez. 2016. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-829843

ABSTRACT

RESUMO Objetivo: avaliar os impactos e fatores determinantes no cumprimento do bundle para redução da pneumonia associada à ventilação mecânica. Método: estudo longitudinal retrospectivo, descritivo, com abordagem quantitativa, realizado no Hospital público de ensino. Coleta realizada entre maio de 2014 e abril de 2015. Participaram da pesquisa, os pacientes da UTI, notificados com PAV. Para a organização dos dados foi utilizado o programa Microsoft Excel 2010. Estabeleceu-se uma análise crítica entre os dados levantados e as taxas de infecção. A pesquisa obteve parecer favorável, sob o n° 566.136. Resultados: observou-se aumento na incidência de PAV após implementação do bundle; os patógenos prevalentes foram bactérias gram-negativas. Os óbitos foram iguais ou maiores a 50%. As mudanças de profissionais e a falta de insumos foram fatores determinantes. Conclusão: nesse contexto, ressalta-se a necessidade de qualificação permanente da equipe, com o propósito de favorecer a adesão ao protocolo e prevenir a PAV.


RESUMEN Objetivo: evaluar los impactos y factores determinantes en el cumplimiento del bundle para reducir la neumonía asociada a la ventilación mecánica (NAV). Método: se trata de un estudio descriptivo retrospectivo longitudinal con un enfoque cuantitativo, realizado en el hospital público universitario. La recolección de datos se ha llevado a cabo entre mayo de 2014 y abril de 2015. Los participantes fueron los pacientes de la UCI reportados con NAV. Para la organización de los datos se utilizó el programa Microsoft Excel 2010. Se estableció un análisis crítico de los datos recogidos y las tasas de infección. La investigación fue aprobada bajo el número de registro 566.136. Resultados: hubo un aumento en la incidencia de NAV después de la implementación del bundle; los patógenos prevalentes fueron las bacterias gramnegativas. Las muertes eran igual o superior al 50%. Cambios profesionales y la falta de insumos fueron factores determinantes. Conclusión: en este contexto, se destaca la necesidad de una formación continua del personal, con el fin de promover la adhesión al protocolo y prevenir la NAV.


ABSTRACT Objective: Assessing the determining impacts and factors in ventilator-associated pneumonia (VAP) bundle. Method: descriptive retrospective longitudinal study, with quantitative approach, held at a public teaching hospital. Collection held between May 2014 and April 2015. Patients of the ICU with VAP participated in the research. For organizing data, the Microsoft Excel 2010 program was used. A critical analysis between the data collected and infection rates was performed. The survey was approved under no. 566,136. Results: an increase in the incidence of VAP after implementing the bundle was observed; the prevalent pathogens were gram-negative bacteria. Deaths were equal to or greater than 50%. Changes of professionals and lack of supplies were determining factors. Conclusion: in this context, the need for permanent qualification of the team is emphasized, with the purpose of promoting the adherence to the protocol and preventing VAP.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Patient Care Bundles , Pneumonia, Ventilator-Associated/epidemiology , Brazil/epidemiology , Intensive Care Units , Longitudinal Studies , Outcome Assessment, Health Care , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/etiology , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/prevention & control , Retrospective Studies , Risk Factors
11.
Braz. j. infect. dis ; 20(5): 468-475, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: biblio-828141

ABSTRACT

Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Sonication/methods , Intensive Care Units, Pediatric/statistics & numerical data , Biofilms/growth & development , Equipment and Supplies, Hospital/microbiology , Intubation, Intratracheal/instrumentation , Reference Values , Time Factors , Trachea/microbiology , Colony Count, Microbial , Microbial Sensitivity Tests , Equipment Contamination/statistics & numerical data , Reproducibility of Results , Pneumonia, Ventilator-Associated/microbiology , Fungi/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Length of Stay , Anti-Bacterial Agents/therapeutic use
12.
J. bras. pneumol ; 42(3): 203-210, tab, graf
Article in English | LILACS | ID: lil-787489

ABSTRACT

ABSTRACT Objective: Ventilator-associated pneumonia (VAP) is the leading type of hospital-acquired infection in ICU patients. The diagnosis of VAP is challenging, mostly due to limitations of the diagnostic methods available. The aim of this study was to determine whether antibody-coated bacteria (ACB) evaluation can improve the specificity of endotracheal aspirate (EA) culture in VAP diagnosis. Methods: We conducted a diagnostic case-control study, enrolling 45 patients undergoing mechanical ventilation. Samples of EA were obtained from patients with and without VAP (cases and controls, respectively), and we assessed the number of bacteria coated with FITC-conjugated monoclonal antibodies (IgA, IgM, or IgG) or an FITC-conjugated polyvalent antibody. Using immunofluorescence microscopy, we determined the proportion of ACB among a fixed number of 80 bacteria. Results: The median proportions of ACB were significantly higher among the cases (n = 22) than among the controls (n = 23)-IgA (60.6% vs. 22.5%), IgM (42.5% vs. 12.5%), IgG (50.6% vs. 17.5%), and polyvalent (75.6% vs. 33.8%)-p < 0.001 for all. The accuracy of the best cut-off points for VAP diagnosis regarding monoclonal and polyvalent ACBs was greater than 95.0% and 93.3%, respectively. Conclusions: The numbers of ACB in EA samples were higher among cases than among controls. Our findings indicate that evaluating ACB in EA is a promising tool to improve the specificity of VAP diagnosis. The technique could be cost-effective and therefore useful in low-resource settings, with the advantages of minimizing false-positive results and avoiding overtreatment.


RESUMO Objetivo: A pneumonia associada à ventilação mecânica (PAVM) é o principal tipo de infecção adquirida no ambiente hospitalar em pacientes em UTIs. O diagnóstico de PAVM é desafiador, principalmente devido a limitações dos métodos diagnósticos disponíveis. O objetivo deste estudo foi determinar se a avaliação de bactérias revestidas por anticorpos (BRA) pode melhorar a especificidade de culturas de aspirado traqueal (AT) no diagnóstico de PAVM. Métodos: Estudo diagnóstico caso-controle envolvendo 45 pacientes sob ventilação mecânica. Amostras de AT foram obtidas de pacientes com e sem PAVM (casos e controles, respectivamente), e verificamos o número de bactérias revestidas com anticorpos monoclonais conjugados com FITC (IgA, IgM ou IgG) ou anticorpo polivalente conjugado com FITC. Utilizando microscopia de imunofluorescência, foi determinada a proporção de BRA em um número fixo de 80 bactérias. Resultados: A mediana das proporções de BRA foi significativamente maior nos casos (n = 22) que nos controles (n = 23) - IgA (60,6% vs. 22,5%), IgM (42,5% vs. 12,5%), IgG (50,6% vs. 17,5%) e polivalente (75,6% vs. 33,8%) - p < 0,001 para todos. A acurácia dos melhores pontos de corte para o diagnostico de PAVM em relação aos BRA monoclonais e polivalentes foi > 95,0% e > 93,3%, respectivamente. Conclusões: O número de BRA em amostras de AT foi maior nos casos que nos controles. Nossos achados indicam que a avaliação de BRA no AT é uma ferramenta promissora para aumentar a especificidade do diagnóstico de PAVM. A técnica pode ser custo-efetiva e, portanto, útil em locais com poucos recursos, com as vantagens de minimizar resultados falso-positivos e evitar o tratamento excessivo.


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Antibodies, Bacterial/isolation & purification , Antibodies, Monoclonal/isolation & purification , Bacteria/isolation & purification , Pneumonia, Ventilator-Associated/diagnosis , Pneumonia, Ventilator-Associated/microbiology , Trachea/microbiology , Trachea/metabolism , Antibodies, Monoclonal/immunology , Bacterial Load , Bacteria/immunology , Intensive Care Units , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Statistics, Nonparametric
13.
Braz. j. infect. dis ; 19(4): 350-357, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-759271

ABSTRACT

Background:In Brazil, ventilator-associated pneumonia (VAP) caused by carbapenem resis- tant Acinetobacter baumanniiand Pseudomonas aeruginosaisolates are associated with significant mortality, morbidity and costs. Studies on the clonal relatedness of these isolates could lay the foundation for effective infection prevention and control programs.Objectives: We sought to study the epidemiological and molecular characteristics of A. baumannii vs. P. aeruginosaVAP in an adult intensive care unit (ICU).Methods: It was conducted a cohort study of patients with VAP caused by carbapenem resistant A. baumanniiand P'. aeruginosaduring 14 months in an adult ICU. Genomic studies were used to investigate the clonal relatedness of carbapenem resistant OXA-23-producing A. baumanniiand P. aeruginosaclinical isolates. The risk factors for acquisition of VAP were also evaluated. Clinical isolates were collected for analysis as were samples from the environment and were typed using pulsed field gel electrophoresis.Results: Multivariate logistic regression analysis identified trauma diagnosed at admission and inappropriate antimicrobial therapy as independent variables associated with the development of A. baumanniiVAP and hemodialysis as independent variable associated with P. aeruginosaVAP. All carbapenem resistant clinical and environmental isolates of A. baumanniiwere OXA-23 producers. No MBL-producer P. aeruginosawas detected. Molecular typing revealed a polyclonal pattern; however, clone A (clinical) and H (surface) were the most frequent among isolates of A. baumanniitested, with a greater pattern of resistance than other isolates. In P. aeruginosathe most frequent clone I was multi-sensitive.Conclusion: These findings suggest the requirement of constant monitoring of these microor- ganisms in order to control the spread of these clones in the hospital environment.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acinetobacter Infections/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Pneumonia, Ventilator-Associated/microbiology , Pseudomonas Infections/microbiology , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/enzymology , Acinetobacter baumannii/genetics , beta-Lactam Resistance , Cohort Studies , Electrophoresis, Gel, Pulsed-Field , Genotype , Hospitals, University , Intensive Care Units , Molecular Typing , Phenotype , Prospective Studies , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , beta-Lactamases/genetics
14.
J. bras. pneumol ; 40(6): 643-651, Nov-Dec/2014. tab
Article in English | LILACS | ID: lil-732554

ABSTRACT

OBJECTIVE: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. METHODS: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. RESULTS: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). CONCLUSIONS: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. .


OBJETIVO: Comparar a mortalidade em 28 dias e desfechos clínicos em pacientes com pneumonia associada à ventilação mecânica (PAVM) internados em UTI conforme a estratégia diagnóstica utilizada. MÉTODOS: Ensaio clínico randomizado prospectivo. Dos 73 pacientes incluídos no estudo, 36 e 37, respectivamente, foram randomizados para a realização de LBA ou aspiração traqueal (AT). A antibioticoterapia inicial baseou-se em diretrizes e foi ajustada de acordo com os resultados das culturas quantitativas. RESULTADOS: A taxa de mortalidade em 28 dias foi semelhante nos grupos LBA e AT (25,0% e 37,8%, respectivamente; p = 0,353). Não houve diferenças entre os grupos em relação a duração da ventilação mecânica, antibioticoterapia, complicações secundárias, recidiva de PAVM ou tempo de permanência hospitalar e na UTI. A antibioticoterapia inicial foi considerada adequada em 28 (77,8%) e 30 (83,3%) dos pacientes nos grupos LBA e AT, respectivamente (p = 0,551). A mortalidade em 28 dias não se associou com a adequação da antibioticoterapia inicial nos grupos LBA e AT (tratamento apropriado: 35,7% vs. 43,3%; p = 0,553; e tratamento inapropriado: 62,5% vs. 50,0%; p = 1,000). O uso prévio de antibióticos não interferiu no rendimento das culturas nos grupos AT e LBA (p = 0,130 e p = 0,484, respectivamente). CONCLUSÕES: No contexto deste estudo, o manejo dos pacientes com PAVM, baseado nos resultados da cultura quantitativa do aspirado traqueal, resultou em desfechos clínicos semelhantes aos obtidos com os resultados da cultura quantitativa do LBA. (Registro Brasileiro de Ensaios ...


Subject(s)
Aged , Female , Humans , Male , Bronchoalveolar Lavage Fluid/microbiology , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/mortality , Respiration, Artificial/adverse effects , Anti-Bacterial Agents/therapeutic use , Brazil/epidemiology , Intensive Care Units , Length of Stay , Prospective Studies , Pneumonia, Ventilator-Associated/drug therapy , Trachea/microbiology
15.
Braz. j. microbiol ; 45(3): 857-859, July-Sept. 2014. graf
Article in English | LILACS | ID: lil-727014

ABSTRACT

This study evaluated the relationship between previous colonization of the oropharynx and development of ventilator-associated pneumonia through the classification of genomic fingerprint pattern by pulsed-field gel electrophoresis of both oxacillin-resistant and oxacillin-susceptible Staphylococcus aureus isolates obtained from hospitalized patients in an intensive care unit.


Subject(s)
Humans , Carrier State/microbiology , Oropharynx/microbiology , Pneumonia, Staphylococcal/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Genotype , Molecular Epidemiology , Molecular Typing , Pneumonia, Staphylococcal/microbiology , Pneumonia, Ventilator-Associated/microbiology , Staphylococcus aureus/classification , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification
16.
Biomédica (Bogotá) ; 34(supl.1): 67-80, abr. 2014. graf, tab
Article in Spanish | LILACS | ID: lil-712423

ABSTRACT

Introducción. Prevenir las infecciones adquiridas en los hospitales, en especial las causadas por microorganismos resistentes, es una prioridad. Por esta razón, Colombia inició la vigilancia nacional de estos eventos realizando una prueba piloto. Objetivo. Describir el comportamiento de las infecciones asociadas a dispositivos, resistencia bacteriana y consumo de antibióticos en instituciones con unidades de cuidados intensivos durante el 2011. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo en 10 instituciones de salud de Antioquia, Valle del Cauca y Bogotá. Se diseñaron protocolos de vigilancia para cada evento, implementados por profesionales de salud entrenados. Se diseñó una herramienta en línea para la notificación y análisis de tasas de infección, porcentajes de utilización de dispositivos y dosis diarias definidas de antibióticos. Mediante el software Whonet 5.6 se reportaron y analizaron los perfiles y fenotipos de resistencia bacteriana. Resultados. La infección del torrente sanguíneo fue la más frecuente (tasa mayor de 4,8 por 1.000 días-catéter), seguida de la neumonía asociada al respirador e infección urinaria asociada a catéter, con amplia variación entre instituciones. Se observó un mayor consumo de meropenem en las unidades de cuidados intensivos (dosis diarias definidas, 22,5 por 100 camas-día), resistencia elevada a carbapenémicos (>11,6 %) y cefalosporinas de tercera generación (>25,6 %) en enterobacterias en las unidades de cuidados intensivos y en otras áreas de hospitalización. El porcentaje de Staphylococcus aureus resistente a la meticilina fue mayor en otras áreas de hospitalización (34,3 %). Conclusiones. Se trata de la primera aproximación integral a la problemática de estos eventos en Colombia. Es necesario implementar la vigilancia nacional que permita orientar acciones gubernamentales e institucionales para la prevención y control de infecciones, contención de la resistencia y promoción del uso prudente de antibióticos acompañados de un proceso de seguimiento y supervisión.


Introduction: Preventing healthcare associated infections, especially for resistant microorganisms, is a priority. In Colombia, the surveillance of such events was started through a national pilot study. Objective: To describe the epidemiology of device-associated infections, bacterial resistance and antibiotic consumption patterns in institutions with intensive care units (ICU), 2011. Materials and methods: Descriptive observational study in 10 health institutions from three Colombian provinces: Antioquia, Valle del Cauca, and Bogotá. Surveillance protocols were designed and implemented by trained health professionals in each hospital. A web tool was designed for data reporting and analysis. Infection rates, device-use percentages and antibiotics defined daily dose (DDD) were calculated. Bacterial resistance phenotypes and profiles were reported and analyzed using Whonet 5.6. Results: The most common event was bloodstream infection (rate > 4.8/1000 catheter-days) followed by ventilator-associated pneumonia (VAP) and catheter-related urinary tract infection, showing a wide variability among institutions. A high consumption of meropenem in the ICU (DDD 22.5/100 beds-day) was observed, as well as a high carbapenem resistance (> 11.6%) and a high frequency of third generation cephalosporins resistance (> 25.6%) in Enterobacteriaceae in ICUs and hospitalization wards. The percentage of methicillin-resistant Staphylococcus aureus was higher in hospitalization wards (34.3%). Conclusions: This is the first experience in measuring these events in Colombia. It is necessary to implement a national surveillance system aimed at guiding governmental and institutional actions oriented to infection prevention and control, to resistance management and to the promotion of antibiotics rational use, along with a follow-up and monitoring process.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/epidemiology , Cross Infection/epidemiology , Drug Resistance, Multiple, Bacterial , Population Surveillance , Tertiary Care Centers/statistics & numerical data , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Catheter-Related Infections/drug therapy , Catheter-Related Infections/epidemiology , Catheter-Related Infections/microbiology , Colombia/epidemiology , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Utilization/statistics & numerical data , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/drug effects , Gram-Positive Bacteria/isolation & purification , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Intensive Care Units/statistics & numerical data , Pilot Projects , Patients' Rooms/statistics & numerical data , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/microbiology , Population Surveillance/methods , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , Urinary Tract Infections/microbiology
17.
Rev. chil. infectol ; 30(4): 361-367, ago. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-690524

ABSTRACT

Background:Accumulation of bacteria in the pharynx is one of the risk factors of pneumonia due to ventilation. One of the methods of prevention from accumulation of bacteria in the pharynx is the use of oral solutions. Chlorhexidine is considered as the gold standard, but it has various side effects. Aim:Present study was aimed to determine and compare anti-bacterial effects of the chlorhexidine gluconate 0.2%, herbal mouthwash of Matrica® (chamomile extracts) 10%, PersicaTM 10% and normal saline in intensive care unit patients. Methods:In this double blind randomized clinical trial, 80 patients who were admitted in ICU divided into four groups of 20 patients each one. Researchers applied PersicaTM to group one, chlorhexidine gluconate mouth wash 0.2% to group two and third group received Matrica, finally in the control group, normal saline were used. In order to culturing of Staphylococcus aureusand S. pneumoniae,salivary samples were obtained without any stimulation after six minimums oral rinsing. The data were processed in SPSS17 software and analyzed by appropriate statistical tests. Results:Decreased rate of bacterial colonies after intervention in the whole four groups was significant (p < 0.001). The mouth wash of chlorhexidine (p < 0.001), PersicaTM (p: 0.008) and Matrica (p: 0.01) had a significant antibacterial effect on S. aureusand S. pneumoniae(p < 0.001). Conclusion:Herbal oral mouthwash of persica and matrica has the effect on S. pneumoniae and S. aureusof oropharynx area in mechanically ventilated patients. However, there is a need for further research to be considered as an alternative to chlorhexidine for prevention of VALP in ICU patients.


Introducción:La presencia y acumulación de bacterias en la cavidad oral es un factor de riesgo para el desarrollo de neumonía asociada a ventilación mecánica. Uno de los métodos para prevenir esta acumulación en la faringe es el uso de soluciones orales. Al respecto, clorhexidina es considerada el estándar de oro, pero tiene varios efectos colaterales. Objetivo:Determinar y comparar el efecto antibacteriano de gluconato de chorhexidina al 0,2%, aseo bucal con preparado en base a hierba matrica (extracto de chamomile) al 10%, Persica® al 10% y solución salina fisiológica (NaCl 9%0) en pacientes de la unidad de cuidados intensivos ingresados para ventilación mecánica. Métodos:Ensayo doble ciego, randomizado, sobre 80 pacientes ingresados en UCI, divididos en cuatro grupos de 20 miembros cada uno. El grupo I recibió Persica®, el grupo II aseo bucal con gluconato de clorhexidina al 0,2%, el grupo III recibió matrica y, finalmente, el grupo IV-control recibió solución salina fisiológica. Con la finalidad de cultivar Staphylococcus aureus yS. pneumoniae,se obtuvieron muestras de saliva sin efectuar estímulo alguno tras un mínimo de seis lavados bucales. Los datos fueron procesados en el software SPSS17 y analizados por tests estadísticos apropiados. Resultados:La disminución en el recuento de colonias bacterianas, después de la intervención, fue significativa en los cuatro grupos (p < 0,001). El aseo bucal con clorhexidina (p < 0,001), Persica® (p: 0,008) y matrica (p: 0,01) tuvo un significativo efecto antibacteriano sobre las especies S. aureusy S. pneumoniae(p < 0,001). Conclusión:El aseo bucal con solución en base a hierbas de Persica® y matrica tiene un efecto sobre S. pneumoniae y S. aureusde la cavidad oral en pacientes en régimen de ventilación mecánica. No obstante, se requiere de mayores estudios para considerarlo una alternativa a clorhexidina para la prevención de neumonías en pacientes de UCI.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/administration & dosage , Chlorhexidine/analogs & derivatives , Mouthwashes/administration & dosage , Plant Preparations/administration & dosage , Pneumonia, Ventilator-Associated/prevention & control , Prunus/chemistry , Anti-Bacterial Agents/pharmacology , Colony Count, Microbial , Chlorhexidine/administration & dosage , Chlorhexidine/pharmacology , Double-Blind Method , Mouthwashes/pharmacology , Plant Preparations/pharmacology , Pneumonia, Ventilator-Associated/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/growth & development , Staphylococcus aureus/isolation & purification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/growth & development , Streptococcus pneumoniae/isolation & purification
18.
Rev. Soc. Bras. Med. Trop ; 46(1): 39-44, Jan.-Feb. 2013. graf, tab
Article in English | LILACS | ID: lil-666792

ABSTRACT

INTRODUCTION: Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilator-associated pneumonia in a clinical-surgical intensive care unit (ICU). METHODS: Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B). RESULTS: Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27- and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporins-resistant Enterobacteriaceae (p = 0.01) isolates in this same period. CONCLUSIONS: Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.


Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Intensive Care Units/statistics & numerical data , Pneumonia, Ventilator-Associated/microbiology , Critical Care , Cross-Sectional Studies , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Incidence , Inappropriate Prescribing/adverse effects
19.
EMHJ-Eastern Mediterranean Health Journal. 2013; 19 (10): 883-887
in English | IMEMR | ID: emr-159113

ABSTRACT

Ventilator-associated pneumonia is the most common health-care-associated infection in the intensive care unit [ICU] and computer-assisted diagnosis and surveillance is called for. The frequency of ventilator-associated pneumonia was assessed prospectively during a 6-month period in the ICUs of a teaching hospital in Tehran, Islamic Republic of Iran. To determine the accuracy of the Iranian Nosocomial Infections Surveillance [INIS] system, patient data were input to the software and compared with physicians'judgement. The frequency of ventilator-associated pneumonia was 21.6%, or 9.96 episodes per1000 ventilator days. The duration of admission to the ICU, duration of mechanical ventilator and number of re-intubations were significantly higher in patients who developed pneumonia. The INIS system identified 100% of cases, with no false-positive or false-negative results. Compared with developed countries, the frequency of ventilator-associated pneumonia was high in our ICUs, and INIS software was accurate in diagnosing nosocomial infection


Subject(s)
Humans , Male , Female , Sentinel Surveillance , Cross Infection/epidemiology , Software , Time Factors , Pneumonia, Ventilator-Associated/microbiology , Hospitals, Teaching , Intensive Care Units , Length of Stay , Incidence
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