Surveillance of multidrug-resistant bacteria in pediatric and neonatal intensive care units in Rio de Janeiro State, Brazil

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.

O Ensino de Gestão de Antimicrobianos em Escola Médica do Rio de Janeiro / Teaching Antimicrobial Stewardship at a Rio de Janeiro Medical School

RESUMO Introdução Programas de gestão de antimicrobianos (PGA) são ferramentas importantes para minimizar o problema global da resistência antimicrobiana. As bases destes programas devem começar idealmente na graduação médica. Objetivo Identificar a apresentação dos conceitos dos PGA no currículo de uma escola médica. Material e métodos Estudo transversal realizado com docentes da Universidade Federal Fluminense (UFF). O critério de inclusão utilizado foi ministrar conteúdos relativos a PGA para o curso de Medicina. Foram mensurados apresentação de componentes-chave dos PGA, carga horária destinada, metodologias de ensino e avaliações empregadas. Resultados Estudo realizado entre dezembro de 2017 e janeiro de 2018, sendo incluídos 6 dos 329 (1,8%) docentes que ministravam aulas para o curso de Medicina. A carga horária destinada à apresentação dos PGA totalizou 83 horas, com mediana de 3 h/docente, o que correspondeu a 1,1% da carga horária total do curso inteiro. Cinco dos seis professores (83,3%) apresentaram pelo menos um dos componentes-chave dos PGA. A frequência de apresentação dos componentes-chave dos PGA foi de: especificidade do tratamento (5/6 - 83,3%), duração do tratamento (4/6 - 66,7%), otimização do tempo de administração (4/6 - 66,7%), possibilidade de troca de via de administração (3/6 - 50%) e monitorização de níveis séricos (2/6 - 33,3%). Quatro dos seis docentes (66,7%) utilizaram combinações de metodologia de ensino, as quais foram reportadas nas seguintes frequências: aulas tradicionais (5/6 - 83,3%), estudos de casos clínicos (4/6 - 66,7%) e aprendizado baseado em problemas (4/6 - 66,7%). Cinquenta por cento dos docentes utilizaram combinações de avaliações para assimilação do conteúdo, e as mais utilizadas foram: respostas dissertativas curtas (3/6), casos clínicos (2/6), perguntas de múltipla escolha (2/6), resumos clínicos (1/6), seminários (1/6) e respostas dissertativas longas (1/6). Conclusões Verificamos que os componentes-chave relativos aos PGA foram apresentados em uma escola médica do Rio de Janeiro, sendo a combinação de diferentes metodologias de ensino a principal estratégia para transmissão dos conceitos. Metade dos docentes utilizou combinação de avaliações para mensurar o conteúdo apresentado. Há necessidade de ajustes para que aspectos importantes, como troca de via de administração e monitorização de níveis séricos, sejam mais debatidos na graduação.

ABSTRACT Introduction Antimicrobial stewardship programs (ASP) are important tools in the effort to reduce the global issue of antimicrobial resistance. Ideally, the foundations of ASP should start to be conveyed in undergraduate medical training. Aim To identify the presentation of ASP concepts in the curriculum of a medical school. Material and methods A cross-sectional study conducted among medical teachers from the Universidade Federal Fluminense (UFF). The inclusion criterion was teaching ASP-related content in the undergraduate medical course. We analyzed which key-concepts were presented, the number of hours dedicated to presentation, the teaching methodologies and the evaluation methods. Results The study was conducted between December 2017 and January 2018 and included six of the 329 (1.8%) teachers who taught on the Medicine course. The total hours dedicated to ASP teaching was 83; median of 3h/teacher, corresponding to 1.1% of the total class hours for the whole course. Five out of six (83.3%) teachers present at least one key component of ASP. The frequency of key ASP concepts presented was: specificity of treatment (5/6 - 83.3%), duration of treatment (4/6 - 66.7%), optimization of administration time (4/6 - 66.7%), possible switching of administration method (3/6 - 50%) and therapeutic drug level monitoring (2/6 - 33.3%). Four out of six (66.7%) teachers used combinations of teaching methodologies, which were reported in the following frequency: lectures (5/6 - 83.3%), clinical cases (4/6 - 66.7%) and problem-based learning (4/6 - 66.7%). Fifty percent of the teachers employed combined evaluations to measure the concepts presented and the most common used were: short dissertation questions (3/6), clinical cases (2/6), multiple choice questions (2/6), clinical summaries (1/6), seminars (1/6) and long dissertation questions (1/6). Conclusions We verified that key ASP-related concepts were presented in a Rio de Janeiro medical school, with a combination of different methodologies constituting the main strategy to convey the concepts. Combinations of evaluations were used by half of the teachers to measure the contents presented. A requirement is observed to improve the teaching of important aspects such as when it is possible to switch the administration method and monitoring of the therapeutic drug level.