Enterobacteriaceae resistant to third generation cephalosporins upon hospital admission: risk factors and clinical outcomes

Objectives: Evaluate risk factors and clinical outcomes of infections caused by Enterobacteriaceae resistant to third-generation cephalosporins present in samples collected upon hospital admission. Methods: Risk factors were evaluated using a 1:2 ratio case-control study. Influence of resistance on the appropriateness of antibiotic therapy, length of stay, and hospital mortality were prospectively evaluated. Characteristics independently associated with the presence of resistant enterobacteria were assessed by logistic regression. Results: Enterobacteria resistant to third-generation cephalosporins were quite common (26.0%). Male gender (OR: 2.66; 95% CI, 1.17-5.06; p = 0.019), invasive prosthesis (OR: 3.79; 95% CI, 1.29-11.08; p = 0.015), previous use of cephalosporins (OR: 2.77; 95% CI, 1.10-6.97; p = 0.029) and hospitalization in the last 6 months (OR: 5.33; 95% CI, 2.29-12.44; p < 0.001) were independently associated with the presence of these microorganisms. These bacteria were associated with higher frequency of inappropriate antimicrobial therapy, worse clinical response, and longer length of stay. Finally, older age, admission to the ICU, and site of infection other than urinary tract were independently associated to higher hospital mortality. Conclusions: Risk factors identified in this study may help in the choice of empirical antibiotic therapy for infected patients suspected of harboring these bacteria and in the early implementation of measures to avoid the spread of these bacteria in the hospital environment. .

A atenção primária à saúde no município de Ouro Preto ? MG: relato baseado na experiência do internato de saúde coletiva / Primary health care in Ouro Preto, Minas Gerais, Brazil: a report based on the experience of collective health internship

O Sistema Único de Saúde (SUS) no Brasil, criado na Constituição Federal de 1988, enuncia todos os conceitos e medidas práticas de Estado para promover, proteger e recuperar a saúde humana no território nacional. A principal porta de entrada para o SUS se constitui das Unidades de Atenção Primária à Saúde (APS), que são capazes de identificar os fatores potencialmente danosos à saúde e atuar no sentido de seu equacionamento e resolução. Adicionalmente, lhes compete cuidar das demandas clínicas, seja no nível primário da atenção, seja por encaminhamento e recebimento posterior de contrarreferência dos casosque necessitam de mais incorporação tecnológica e de avaliação por especialistas. Este artigo apresenta a experiência na APS a partir da vivência discente supervisionada durante o Internato de Saúde Coletiva (?Internato Rural?) realizado ao longo do quarto trimestre de 2011, no município de Ouro Preto, Minas Gerais. Intenciona também promover reflexões acerca do conteúdo teórico de sua constituição e da realidade de sua prática.

The Brazilian Unified Health System (SUS), created in 1988 Federal Constitution, enunciates all State concepts and practical measures to promote, protect, and recover human health in the national territory. The main entrance door for the SUS is made of Health Primary Care Units (APS), which are able to identify the potentially damaging factors tohealth, and to act as its guidance and resolution. In addition, they are in charge of taking care of clinical demands, be them in care primary level, be for following and posterior reception of counter-reference cases that need more technological incorporation and evaluation by experts. This article represents the experience at the APS from a supervised schoolvisit during the Collective Health Internship (?Rural Internship?) carried out throughout 2011 fourth trimester, in Ouro Preto, Minas Gerais, Brazil. It also intends to promote reflections about the theoretical content of its constitution and its practice reality.